There was a significant association between the G-allele number at the PNPLA3 rs738409 and NAFLD when adjusted for age, gender and BMI (OR 1.57, 95% CI 1.15–2.16, P = 0.005), which means that possessing each G allele at rs738409 could increase the risk of childhood NAFLD by 57%. Here, PNPLA3 is linked to metabolic dysfunction-associated steatotic liver disease.