TNF and metabolic dysfunction-associated steatotic liver disease: Previous studies have shown that TNF-α levels are increased in NASH subjects compared to controls and also that TNF-α levels are correlated with HOMA-IR and NAFLD severity (14, 27).Consistent with the present findings, Plessis et al. revealed that TNF-α levels increased in patients with NASH and were associated with liver enzymes (28, 29).