NASH is also associated with increased serum insulin and triglyceride concentrations, accompanied by elevated levels of very-low-density lipoprotein cholesterol and reduced levels of high-density lipoprotein cholesterol.[18, 19] IR and hyperlipidemia are common in patients with NASH, as are metabolic disorders and visceral obesity.[2] Expansion of white adipose tissue may contribute to disease progression through the production of adipokines, inflammatory cytokines and lipids.[20, 21]. This evidence concerns the gene INS and metabolic dysfunction-associated steatohepatitis.