The recent findings by Strnad et al. [13] showed that the SERPINA1 Z-allele was associated with disease severity and an increased risk of developing cirrhosis in patients with NAFLD and ALD, which was particularly significant as the association was independent of PNPLA3, TM6SF2 and MBOAT7, and was numerically stronger than that of other risk variants for the development of NAFLD/ALD cirrhosis. Here, PNPLA3 is linked to metabolic dysfunction-associated steatotic liver disease.