FGF19 and steatosis: There is a strong association between impaired fibroblast growth factor 19 (FGF19) signaling and elevated levels of BAs in circulation.208–210 FGF19 modulates hepatic fat metabolism via multiple mechanisms, including accelerating lipid oxidation and repressing hepatic DNL, subsequently protecting the liver from steatosis.211 Aldafermin (NGM282), an engineered analog of the gut hormone FGF19, showed a tendency towards reducing liver fat and improving fibrosis yet with adverse events, including diarrhea, abdominal pain, and nausea in NASH patients.212–214