Other possible mechanisms to improve insulin sensitivity in NAFLD reported in the literature include the regulation of the acetyl-CoA/CoA ratio in mitochondria, modulation of the pyruvate dehydrogenase complex (PDHC) activity, altering the expression of glycolytic and gluconeogenic enzymes as well as the expression of genes associated with the insulin signaling cascade, and stimulation of the insulin-like growth factor-1 (IGF-1) axis and IGF-1 signaling cascade (34, 55). Here, IGF1 is linked to metabolic dysfunction-associated steatotic liver disease.