Additionally, PHG together with NAFLD elevated GR activity compared to all groups except NAFLD+ALA (PHG: +6.9%; NAFLD: -19.9%; NAFLD+PHG: +57.1% p < 0.0001; NAFLD+NAC: +13.7%, NAFLD+ALA: +26.3%). Here, GSR is linked to metabolic dysfunction-associated steatotic liver disease.