It has been suggested that in some patients with severe NAFLD, decreased expression of the enzyme glycine N-methyltransferase (GNMT) results in an increased serum concentration of methionine and its metabolite S-adenosylmethionine (SAMe), both known inactivators of autophagy which might lead to impaired lipophagy (97). This evidence concerns the gene GNMT and metabolic dysfunction-associated steatotic liver disease.