ACLY and hyperinsulinism: In addition, the compensatory hyperinsulinemia activates the hepatic de novo lipogenesis (DNL) through sterol regulatory element-binding proteins (SREBP1, SREBP2), ATP-citrate lyase (ACLY), acetyl-CoA carboxylase (ACC) and fatty acid synthase (FASN), which provide precursors for TG synthesis, thus exacerbating LDs accumulation [31].