It has been recognized that some patients with NAFLD do not develop obesity and insulin resistance, even though they have higher lipid content in the liver.[21] Notably, several recent studies have shown that some of these patients have reduced polyunsaturated PLs in the liver, similar to the lipid profile of LKO livers.[22] Thus, our study shed light on the underlying mechanisms of how these patients maintain insulin sensitivity despite massive lipid accumulation. This evidence concerns the gene INS and metabolic dysfunction-associated steatotic liver disease.