Overall, no significant association was evident between RASi use and NAFLD development or progression (NAFLD development; ever-user vs. never-user: OR 1.017; 95% CI 0.842–1.230, NAFLD progression; ever-user vs. never-user: aOR 0.942; 95% CI 0.803–1.105). Here, MMP19 is linked to metabolic dysfunction-associated steatotic liver disease.