INS and Insulin resistance: In addition, fetuin-A induces insulin resistance and inflammation via multiple mechanisms, including the activation of the extracellular signal regulated-kinase-nuclear factor kappaB (ERK-NF-κB) pathway 29, promoting saturated fatty acid-induced activation of toll-like receptor 4 30, inducing proinflammatory cytokine production in monocytes and adipocytes 31, and inhibiting insulin-sensitizing adiponectin production 32.