INS and obesity due to melanocortin 4 receptor deficiency: In 1980, Ludwig et al, noticed fatty infiltration in the liver biopsy of nonalcoholic patients.[1] Later, NAFLD was observed in diabetes mellitus (DM) and obesity.[2, 3] In type 2 diabetes, NAFLD occurs in up to 75% of patients.[4] In obesity, NAFLD and hepatic fibrosis are prevalent.[5] In fact, DM is an independent risk factor for liver-related deaths in NAFLD.[6] Obesity and DM are often accompanied by insulin dysregulation of glucose and lipid metabolism.