Kitamoto et al. [36] demonstrated that Matteoni type4 NAFLD is both a genetically and clinically different subset from the other spectrums of the disease and that the PNPLA3 gene is strongly associated with the progression of nonalcoholic steatohepatitis (NASH) in Japanese, whose BMI is lower than that of the United States and European countries [37]–[39]. This evidence concerns the gene PNPLA3 and metabolic dysfunction-associated steatotic liver disease.