Indeed, obese adolescents with a high ratio, relative to even more obese individuals with lower ratios, demonstrate a markedly adverse metabolic phenotype of severe insulin resistance and alterations in glucose and lipid metabolism.75 Moreover, intrahepatic fat, while strongly associated with high levels of visceral fat, is independently associated with the insulin-resistant state in obese adolescents, independent of all other fat depots.76 This evidence concerns the gene INS and Insulin resistance.