We also noted elevated expression of hepatic transforming growth factor beta induced protein (TGFBI) (also increased in NAFLD plasma)48, SMAD-3 and -7, FGF7 (which correlates with hepatic fibrosis severity121,122 and suppresses CYP7A1 during fibrosis development123), FGFR2 and FGFR3. Collectively, this indicated a pro-tissue remodelling/pro-fibrotic hepatic environment developing. This evidence concerns the gene SMAD3 and metabolic dysfunction-associated steatotic liver disease.