INS and metabolic dysfunction-associated steatotic liver disease: Genetic factors also account for a significant percentage of hepatic fat variability.91 Single nucleotide polymorphisms in genes involved in lipid metabolism (Lipin 1, patatin-like phospholipase domain containing-3 [PNPLA3]), oxidative stress (superoxide dismutase 2), insulin signaling (insulin receptor substrate-1), and fibrinogenesis (Kruppel-like factor 6) are associated with a risk for the development and progression of NAFLD.92