Hepatocytes actively secrete hepatokines, which are proteins that can influence metabolic processes through autocrine, paracrine, and endocrine signaling [81,82,83], such as Fetuin-A, often elevated in NAFLD [84], which was found to promote endothelial and vascular dysfunction in NALFD via tol-like receptor-4 (TLR-4) and tumor necrosis factor-α (TNF-α) [82]. Here, TNF is linked to metabolic dysfunction-associated steatotic liver disease.