This is in line with the model that common genetic variants combined with modifier variables (genes or other factors such as obesity and insulin resistance) together lead to elevations in plasma TG levels [4] and it is in accordance with the mechanism by which also mutations in the near APOA5 gene cause hypertriglyceridemia, requiring a second factor to express the clinical phenotype [20]. Here, APOA5 is linked to obesity due to melanocortin 4 receptor deficiency.