INS and obesity due to melanocortin 4 receptor deficiency: This synergistic burden is likely mediated through an obesity-induced chronic inflammatory and insulin-resistant state, leading to disrupted lipid metabolism [37], increased fatty acids flux to the liver, enhanced intrahepatic expression of genes involved in TG biosynthesis, and impaired clearance of TG-rich lipoprotein particles, thus exacerbating HTG [38,39].