PNPLA3 and metabolic syndrome: Steatosis, which is the accumulation of fat in >5% of hepatocytes, is a hallmark of NAFLD.200 Diabetes, insulin resistance, metabolic syndrome, and mutations in the genes PNPLA3 (patatin-like phospholipase domain-containing protein 3) and TM6SF2 (transmembrane 6 superfamily member 2) are contributing factors to NAFLD.201–203 Accumulating evidence suggests that structural and bioenergetic changes to the mitochondria are involved in the pathogenesis causing NAFLD, which may progress into non-alcoholic steatohepatitis.