Conversely, given the increased NAFLD severity observed in patients with coexisting T2DM, it is also likely that an increased hepatic expression of GDF-15, due to hepatic inflammation and/or fibrosis and exacerbated by the presence of T2DM, also contributes to elevations in circulating concentrations of GDF-15. This evidence concerns the gene GDF15 and metabolic dysfunction-associated steatotic liver disease.