A study of US adults showed that the higher levels of L and Z carotenoid intake may reduce the risk of NAFLD [37] and inhibit the progression of simple hepatic steatosis to nonalcoholic steatohepatitis (NASH) by reducing oxidative stress responses in the liver and pro-inflammatory cytokines secreted by liver macrophages, as well as by reducing immune infiltration and insulin sensitivity [11]. Here, INS is linked to fatty liver disease.