INS and obesity due to melanocortin 4 receptor deficiency: In patients with MASLD and obesity, the increased activity and expression of microsomal cytochrome P450 (CYP) 2E1 and CYP4A11 was observed, with this increase showing a significant correlation with elevated levels of circulating ketone bodies and FFAs, high-density lipoprotein, triglycerides, insulin, and insulin resistance (Aljomah et al. 2015; Gao et al. 2020).