INS and metabolic dysfunction-associated steatotic liver disease: So, in conclusion, the mechanisms of insulin resistance, fat accumulation, mitochondrial dysfunction, oxidative stress, ER stress and ROS production, in association with genetic or epigenetic factors which can alter NAFLD predisposition, affect the fat content of hepatocytes, as well as hepatic pro-inflammatory pathways, culminating in chronic hepatic inflammation which can evolve into hepatocellular death, and activation of hepatic stellate cells that drive fibrogenesis [5].