a single-nucleotide polymorphism (rs738409; C>G/I148M) in the patatin-like phospholipase domain containing 3 ( PNPLA3 , adiponutrin) gene, to be strongly associated with NAFLD. A meta-analysis of 16 studies demonstrated that homozygous carriers of PNPLA3 I148M have on the average a 73% higher liver fat content than weight-matched homozygous carriers of the major allele ( 5 ). However, NAFLD associated with PNPLA3I148M is distinct from obesity-associated common NAFLD, as it is not characterized by features of the metabolic syndrome such as hyperinsulinemia or dyslipidemia ( 1, 5 ).In vitro assays using recombinant PNPLA3 have suggested that the WT PNPLA3 (PNPLA3 WT ) hydrolyzes emulsifi ed triacylglycerol (TAG) and that the I148M substitution in PNPLA3 (PNPLA3 I148M ) abolishes this activity ( 6-8 ). Moreover, the protein was shown to display a transacylase activity ( 7 ), and to prefer oleic acid (18:1n-9) as the fatty acyl moiety ( 9 ). Opposing a putative role as a lipase, PNPLA3 is induced by glucose and insulin ( 10-12 ) and is a target gene of the lipogenic transcription factors SREBP-1c and the carbohydrate responsive element binding protein, ChREBP ( 13-16 ). Kumari et al. ( 17 ) suggested that the protein acts as lipogenic lysophosphatidic acid (LPA) acyltransferase, converting LPA to phosphatidic acid (PA), and that the I148M substitution increases this activity. Because PA acts as a precursor for both phospholipids and TAGs, this provided an alternative explanation for the hepatic fat accumulation in the PNPLA3 I148M