Insulin resistance and visceral fat distribution usually play a major role in the development of clinical aspects of the metabolic syndrome, such as dyslipidemia, diabetes and atherosclerosis. In this review, the focus will be on some novel relationships with a fatty liver, for which susceptibility appears to be mediated by the activity of transcription factors, such as sterol regulatory element-binding protein 1 (SREBP-1). In addition to this molecular aspect therapeutic life-style modifications, such as weight reduction which are associated with increased insulin sensitivity and a decrease of fat in the liver will be discussed.