Hence, although PCSK9 inactivation can establish low LDL levels, PCSK9 loss-of-function mutations might concomitantly induce adipocyte hypertrophy in visceral fat depots in a subgroup of patients [33,150], thereby creating a risk factor for insulin resistance, type 2 diabetes and NAFLD [79]. The gene discussed is PCSK9; the disease is metabolic dysfunction-associated steatotic liver disease.