Elevated levels of holo-RBP4 in circulation are correlated to an increase in insulin tolerance, subsequent type 2 diabetes, and obesity, as well as the development of nonalcoholic fatty liver disease (NAFLD), among other metabolic diseases based on several case studies involving observational studies of human patients with RBP4 and retinol deficiencies in circulation, and molecular studies using mouse and cell culture models [20]. Here, RBP4 is linked to metabolic dysfunction-associated steatotic liver disease.