Dongiovanni et al. [63] reported that the ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) K121Q and insulin receptor substrate 1 (IRS-1) Q972R polymorphisms predisposed patients with NAFLD to liver damage and decreased hepatic insulin signaling. This evidence concerns the gene INS and metabolic dysfunction-associated steatotic liver disease.