In conclusion, mild weight loss through an intensive Lifestyle Intervention (ILI) was better than pemafibrate in terms of the main indicators that assess improvement in the pathogenesis of MASLD, since the ILI group, but not the pemafibrate group, improved hepatic steatosis (CAP), FAST score, visceral fat accumulation, and serum HMW adiponectin. Here, ADIPOQ is linked to Hepatic steatosis.