Choline is then converted by liver monooxygenase into trimethylamine n-oxide (TMAO),115 which is considered a novel biomarker for early metabolic syndrome.116 Patients with NAFLD have elevated blood levels of TMAO, which regulates glucose metabolism and causes adipose tissue inflammation as well as abnormal blood glucose levels by increasing serum levels of the inflammatory cytokine C-C motif chemokine 2 (CCL2).117 SCFAs also play a role in metabolic liver disease. This evidence concerns the gene CCL2 and metabolic dysfunction-associated steatotic liver disease.