Immunokines promote not only hepatic, but also systemic IR (83, 84), and cytokines like TNFα are detectable and upregulated in concentration inside the liver and adipose tissue of NASH patients (85), suggesting that upregulated TNFα in adipose might potentiate the progression of NAFLD in two ways: systemic IR and activation of a peripheral inflammation of insulin-responsive tissues (86). Here, INS is linked to metabolic dysfunction-associated steatotic liver disease.