In support of the role of steatosis alone, patients with NAFLD due to genetic risk variants in patatin-like phospholipase domain-containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2) and membrane bound O-acyltransferase domain containing 7 (MBOAT7) develop the full spectrum of NAFLD while they are neither insulin resistant nor at high risk of type 2 diabetes or cardiovascular diseases11–14. The gene discussed is INS; the disease is metabolic dysfunction-associated steatotic liver disease.