This finding is not consistent with those of previously published studies, in which NAFLD was shown to increase insulin resistance, with a compensatory increase in insulin secretion21,22, which is eventually followed by the development of glucose intolerance or DM when this compensatory mechanism fails5–7, while relationships of FIB-4 index with HOMA-β but not with HOMA-R were recently reported in a population-based cross-sectional study of Japanese23. This evidence concerns the gene INS and diabetes mellitus.