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For example, co-administration of L-carnitine and -lipoic acid did not improve insulin resistance but markedly ameliorated mitochondrial ultrastructure and reduced serum liver enzyme levels, suggesting a preferential correction of mitochondrial injury ( / Leiden mice, only the combined intervention with nicotinamide riboside, rather than either monotherapy, significantly attenuated obesity and hepatic steatosis, accompanied by coordinated upregulation of genes involved in fatty acid oxidation and insulin signaling ( depend on enhanced activity of CrAT, which modulates mitochondrial acetyl-CoA metabolism and thereby improves insulin sensitivity and hepatic lipid homeostasis ( Building on these findings, the clinical evidence collated in Table 2 reveals substantial heterogeneity in the therapeutic efficacy of L-carnitine supplementation for MASLD

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