Finally, combining NAFLD-histological variables, levels of circulating metabolites, and genetic markers in a two-stage multicenter case-control study, Sookoian et al. observed decreased levels of betaine in circulation in NASH and an association of genotypes of the missense variant p. Ser646Pro (rs1805074) in DMGDH gene, which encodes for the mitochondrial dimethyl glycine dehydrogenase with disease severity [44]. Here, DMGDH is linked to metabolic dysfunction-associated steatohepatitis.