However, the “Two-hit” hypothesis cannot explain the occurrence and development of MASLD well, and more and more studies show that MASLD is the most common multi-factor disease, so the “Two-hit” theory has been proposed, and the combination of insulin resistance [27], adipokine secretion, mitochondrial dysfunction, oxidative stress, endoplasmic reticulum stress, genetics, and other factors [28] eventually leads to liver damage, leading to the occurrence of MASLD. The gene discussed is INS; the disease is metabolic dysfunction-associated steatotic liver disease.