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Finally, CS may worsen NAFLD by enhancing proinflammatory cytokines, such as tumor necrosis factor alpha, that are known to play a key role in NAFLD8.25-27 Although two studies did not find an association between CS and the presence of NAFLD in the general population28,29 only one published clinical study has looked at the possible effect of CS in patients already identified as having NAFLD.30 In that study, CS exposure was associated with increased ALT