Fat overload leads to adipocyte hypertrophy, hyperplasia, and abnormal adipokine production.385 Chronic ethanol exposure also disrupts the endocrine function of adipose tissue.386 For example, adiponectin, which promotes liver glucose use and fatty acid oxidation, is found to be decreased in MASLD and ALD; however, exogenous supplementation of adiponectin alleviates high-fat diet- and ethanol-induced liver steatosis and insulin resistance.387 Leptin, an adipocyte-derived hormone that inhibits appetite and increases fatty acid oxidation, becomes resistant in MASLD. The gene discussed is ADIPOQ; the disease is Insulin resistance.