INS and metabolic dysfunction-associated steatohepatitis: Recent theories suggest that because simple steatosis is a benign process in many patients, whereas NASH is a progressive process, NASH may have a unique pathogenesis in which the liver is exposed to a combination of insulin resistance, oxidative stress, enteric-derived endotoxins, bacterial endotoxins, altered adipocytosine profile, and reduced bile secretion, leading to an inflammatory response [7].