It is possible that the different evaluation methods, such as US and liver biopsy, and different ethnicity or different distribution of PNPLA3 rs738409 genotypes might have different association with hepatic steatosis and liver fibrosis in Japanese patients with chronic hepatitis C. We also could not completely rule out the possibility that there exist different mechanisms of hepatic steatosis and liver fibrosis between NAFLD and hepatitis C [7]–[9]. This evidence concerns the gene PNPLA3 and metabolic dysfunction-associated steatotic liver disease.