ACOX and branch-chained acyl-CoA oxidase (another peroxisomal enzyme involved in FAO) mRNA levels were higher in patients with NAFLD compared to controls, indicating that peroxisomal FAO upregulation may be a compensatory response aiming to resolve the progressing steatosis in NAFLD [45, 107]. Here, ACOX1 is linked to metabolic dysfunction-associated steatotic liver disease.