Dysfunction of insulin function and T2DM also has a pivotal role in fatty liver disease development.74 Progressive ER stress contributes to the development of NFLD and nonalcoholic steatohepatitis by different molecular mechanisms, including lipogenesis, inflammation, apoptosis, and autophagy.105 Documents showed that Ex-4 can alleviate hepatic steatosis and ER stress via controlling lipin-1β/α ratio and lipid hemostasis through Sirt1 and AMPK signaling pathways.106 Hepatic glycoproteins like SEPP1 and fetuin-A are known as novel biomarkers who participated in insulin resistance and NFLD. Here, SIRT1 is linked to fatty liver disease.