INS and type 2 diabetes mellitus: The relation between type 2 diabetes and NAFLD is well established; there is an increased risk of NAFLD among patients with type 2 diabetes and despite as previously mentioned that the pathogenesis of NAFLD is not fully understood, yet the most accepted theory is “multiple hit theory,” and the first hit being insulin resistance as the most important contributing factor with obesity as the main insulin-resistant state causing inflammatory state and altering lipid metabolism [28, 29].