Given that myosteatosis is closely associated with the pathogenesis of nonalcoholic fatty liver disease, to the extent that it is used as a prognostic indicator in patients with end-stage liver disease,3 the findings from Grapentine et al. strongly suggest that the age-dependent non-alcoholic steatohepatitis (NASH) and insulin resistance reported in global Pcyt2+/− mice5 (but not in liver-specific Pcyt2 knockout mice9) originates, at least in part, from pathological changes within skeletal muscle. Here, PCYT2 is linked to End Stage Liver Disease.