XDH and metabolic dysfunction-associated steatotic liver disease: In fact, the presence of elevated serum urate level is a biomarker and risk factor for fatty liver disease (Jensen et al., 2018), and greater XDH activity has been suggested as a causative factor for the development of insulin resistance and NAFLD through increasing oxidative stress via production of hydrogen peroxide (Kelley et al., 2010; Xu et al., 2015).