A total of 90 patients attended with NAFLD (without T2DM), variable ages from 20 to 65 years old, and BMI of more than 40 kg/m2. 10 mg/day of EMPA was taken by patients in the experimental group, and a placebo tablet was taken by the placebo group for 24 weeks. After the trial, there was a remarkable decline in BMI, waist circumference, weight, fasting insulin level, aspartate transaminase level, and alanine transaminase level in the EMPA group. 9.3% of this group fully recovered from fatty liver. Here, INS is linked to metabolic dysfunction-associated steatotic liver disease.