PNPLA3 and Insulin resistance: Moreover, a combination of PNPLA3 I148M genotype with a surrogate marker of insulin resistance (namely, the enhanced lipoprotein insulin resistance index by magnetic resonance spectroscopy) could improve the identification of MASH (defined by a NAFLD Activity Score [NAS] ≥ 3) with an area under the curve (AUC) of 0.82 [55].