Besides, in pediatric population with obesity, a low adherence of MedDiet (evaluated by a clinical questionnaire, the Mediterranean diet quality, index for children and adolescents, KIDMED) was significantly higher in NASH cases, and poor adherence correlated with liver damage (NAFLD activity >5, and grade 2 fibrosis), and higher fasting insulin levels [81]. Here, INS is linked to metabolic dysfunction-associated steatohepatitis.