Another recent study reported that in subjects with alcoholic cirrhosis following adjustment for fat mass, visfatin levels were significantly higher from Child-Pugh Class A to Class C. Furthermore, leptin, the first described adipokine, interplays with hepatic metabolism, and data from a small study suggest that recombinant leptin administration has a possibly beneficial effect on steatosis, but not fibrosis, in NAFLD patients with hypo-leptinemia and a very recent study reported that in non-alcoholic steatohepatitis (NASH), leptin is upregulated, and promotes liver fibrosis by directly activating hepatic stellate cells (HSC) via the hedgehog pathway and the hedgehog-regulated osteopontin (OPN).