IGF1 and metabolic dysfunction-associated steatotic liver disease: NAFLD can be ameliorated by calorie restriction, which leads to the suppressed growth hormone/insulin-like growth factor-1 (IGF-1) somatotroph axis, a conserved regulator of lifespan that triggers the activation of the cellular protective program and the re-allocation of resources from growth to somatic preservation.1–9 Paradoxically, suppression of the somatotroph axis is associated with patients with NAFLD and, in particular, is correlated with the severity of fibrosis.10–19 Whether the somatotroph axis controls liver damage during the progression of NAFLD is unknown.