Deficiency of peroxisomal enzymes [e.g. acyl-coenzyme A oxidase (Acox1) or peroxisomal biogenesis factor 11α (Pex11α)] resulted in impaired peroxisomal β-oxidation, increased lipid accumulation and exacerbated hepatocellular damage [35, 36], indicating the indispensable role of peroxisomes in lipid metabolism in the context of NAFLD. This evidence concerns the gene PEX11A and metabolic dysfunction-associated steatotic liver disease.