van den Berg EH, et al. - In 7,622 participants of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort, researchers examined the association of paraoxonase-1 (PON-1; HDL-associated anti-oxidative enzyme) with suspected non-alcoholic fatty liver disease (NAFLD) by measuring serum enzyme activity. In 2,083 participants (27.3%), the presence of fatty Liver Index (FLI)≥60, a proxy of NAFLD, was reported. FLI≥60 coinciding with an increased prevalence of type 2 diabetes mellitus (T2D), metabolic syndrome (MetS), (central) obesity, elevated triglycerides and low HDL cholesterol was reported. Findings revealed a paradoxically maintained PON-1 that may even be increased in NAFLD, although inverse associations with metabolic disorders and low HDL cholesterol were evident.