PNPLA3 and metabolic syndrome: In support of this concept, Luukkonen et al. (2016) observed that the liver lipidome of patients with elevated IHTG content and multiple features of metabolic syndrome, and who were not carriers of the common I148M variant in patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene (‘metabolic NAFLD’; Box 1) was markedly enriched in saturated and monounsaturated TG, as well as in free FAs, markers of de novo ceramide synthesis, and ceramides, compared to patients without metabolic NAFLD.