Vitamin E has preventive and protective effects on MASLD by improving hepatic steatosis (FLI, L/S ratio), insulin resistance (HOMA-IR), oxidative stress (MDA), inflammation (hs-CRP, TNF-α, IL-6, leptin, adiponectin), and hepatocyte apoptosis (CK18-M30). The gene discussed is KRT18; the disease is metabolic dysfunction-associated steatotic liver disease.