Exemplifying such inter-organ metabolic regulation, the secretion of the hepatokine α-2-HS-glycoprotein (AHSG/fetuin-A) was shown to be increased in obese, insulin resistant and NAFLD patients [8] and to alter muscle insulin sensitivity [9,10] and adipocyte functions by interacting with Toll-like receptor 4 (TLR4) [11,12]. Here, INS is linked to metabolic dysfunction-associated steatotic liver disease.