Patients with both steatosis and inflammation (i.e. nonalcoholic steatohepatitis, NASH) have worse outcomes than those with bland steatosis.11,12 Similarly, patients with NAFLD-associated cirrhosis have worse outcomes than those who do not.8 Interestingly, although cirrhosis strongly predicts HCC, some NAFLD patients develop HCC in the absence of cirrhosis.13 Hispanic populations tend to have higher rates of NAFLD;14 a variant in PNPLA3 associated with hepatic steatosis and NASH has been identified and is more common among Hispanic individuals.15 This evidence concerns the gene PNPLA3 and steatosis.