Adipocytes respond maladaptively to chronic energy surplus, resulting in adipocyte hypertrophy.9 Fat-swollen adipocytes become insulin resistant, decrease expression of adipokines such as the anti-inflammatory insulin-sensitizer adiponectin, and increase expression of the satiety factor leptin.10 Stressed adipocytes undergo cell death in mice with genetic- or diet-induced obesity, and in morbidly obese humans.9, 11 Adipocyte cell size and cell death correlate with the presence of metabolic syndrome, insulin resistance and NAFLD.9, 10, 12. This evidence concerns the gene INS and metabolic dysfunction-associated steatotic liver disease.