Accumulating studies have found that abnormal expression of ERS-related proteins, such as GPR78, p-PERK, and ATF6, were detected in liver cells of patients with obesity or NAFLD [28], which were involved in the pathology process of NAFLD, including hepatic steatosis, insulin resistance, inflammation and apoptosis. This evidence concerns the gene GPR78 and metabolic dysfunction-associated steatotic liver disease.