INS and fatty liver disease: This is in line with the results from the study of Papandreou et al., who demonstrated that the majority of children with hepatic steatosis assessed by USG fulfilled three or more criteria of MetS (58.6%) and showed significantly higher BMI, WC, TG, and lower HDL-C levels, as well as higher fasting insulin levels and higher IR assessed based on HOMA-IR, compared to patients with normal echogenicity of the liver.