Harrison et al. (19) developed and externally validated a new blood-based non-invasive diagnostic model, namely, the NIS4 score, consisting of the following four metrics: miR-34a-5p, α-2 macroglobulin, CHI3L1, and glycated hemoglobin, specifically designed to identify patients with metabolic risk factors (type 2 diabetes mellitus, obesity, dyslipidemia, and hypertension) in patients with high-risk NASH (including those with an NAFLD activity score ≥ 4 and fibrosis stage ≥2). Here, CHI3L1 is linked to obesity due to melanocortin 4 receptor deficiency.