INS and metabolic dysfunction-associated steatotic liver disease: NAFLD is characterized by an impaired response to insulin.[13] IR can cause metabolic imbalance, increase oxidative stress, and amplify the inflammatory response.[14,15] Although the hyperinsulinemic-euglycemic clamp test is the gold standard for assessing IR, the triglyceride glucose index has shown superior sensitivity and specificity for its identification.[16] A pro-inflammatory state has been shown to induce IR.