INS and metabolic syndrome: Fatty liver is not only associated with hepatic complications but also extra hepatic complications, like metabolic syndrome, Type 2 Diabetes mellitus (T2DM), and Hypertension (HTN).7 Essential hypertension itself is considered an insulin resistant state8 and approximately 50% of patients with arterial hypertension are reported to be insulin resistant with hyperinsulinaemia9, and the risk of developing essential hypertension increases in the presence of fatty liver.