INS and obesity due to melanocortin 4 receptor deficiency: The incidence of NAFLD and NASH is increasing due to the obesity and diabetes epidemics.[25] It has been demonstrated that the benefits of metformin in inhibiting hepatic gluconeogenesis, improving hepatic fatty acid metabolism (including inhibition of adipose tissue lipolysis), increasing fatty acid oxidation, inhibiting lipogenesis and enhancing insulin sensitivity.[26] Metformin as a treatment for NAFLD/NASH has been partly examined by pilot studies and randomized controlled clinical trials in the past.