The NIS4 (including miR-34a-5p, alpha-2 macroglobulin, YKL-40, and glycated hemoglobin) and the MACK-3 (including AST, glucose, insulin, and CK 18) are blood-based diagnostic tools that have proven useful in detecting “fibrotic NASH” (defined as NASH + NAS ≥ 4 + fibrosis stage ≥ 2) [155,156]. This evidence concerns the gene INS and metabolic dysfunction-associated steatohepatitis.