Indeed, the association between the I148M variant of PNPLA3, the major risk factor for NASH identified so far, and both liver enzymes and steatosis was soon confirmed in obese children of different ethnicity [55, 56, 271, 272], and in one family study in Italian trios [52], indicating that it exerts its effect early in life. The gene discussed is PNPLA3; the disease is metabolic dysfunction-associated steatohepatitis.