IR, characterized by low sensitivity to insulin and the low glucose disposal in muscle and adipose tissue, is another important risk factor for the development and progression of NAFLD.131, 138, 155 IR has a direct effect on the metabolism of glucose which results in the lipid accumulation via DNL progress and in adipocytes, IR leads to the excessive delivery of FFAs to the liver.117, 119, 156 These above two processes both contribute to the extra lipid accumulation in the liver which could be a start of steatosis. The gene discussed is INS; the disease is metabolic dysfunction-associated steatotic liver disease.