Previous small-scale studies on the possible association of ApoE genotype variation with NAFLD showed conflicting results: no association of the different ApoE alleles with NAFLD [39], a possible protective effect of the ApoE ε4 allele against NAFLD [38,43], a possible protective effect of the ApoE ε2 allele and ApoE ε2ε3 genotype in non-obese NAFLD subjects [40], a higher risk for advanced fibrosis in ApoE ε4 carriers compared with ε3 carriers [41] and an association of increased NASH formation in the ApoE ε3ε3 genotype [42]. Here, APOE is linked to metabolic dysfunction-associated steatohepatitis.