This uncertain role of IL-18 in MASLD is also mirrored in clinical studies; while some studies have reported elevated circulating IL-18 levels in NAFLD patients compared to controls [104, 105], a particular study on male patients with biopsy-proven NAFLD without concurrent metabolic disorders, found no difference in circulating IL-18 between patients with hepatic steatosis and those with NASH [106]. This evidence concerns the gene IL18 and metabolic disease.