In agreement, in the validation cohort, there were also no significant differences in IGF-1 relating to liver steatosis, lobular inflammation, or hepatocyte ballooning severity (Supplementary Figure 3), yet IGF-1 was significantly lower in NAFLD patients with advanced fibrosis (F3–4; p < 0.05) (Figure 4C). Here, IGF1 is linked to metabolic dysfunction-associated steatotic liver disease.