PNPLA3 and hepatocellular carcinoma: In addition, the PNPLA3 variant is also associated with the development of fibrosis and a five-fold increase in the risk of HCC [87]. The membrane-bound O-acyl transferase 7 (MBOAT7) gene involved in phospholipid metabolism has also been identified to increase the risk of NAFLD development and progression, particularly in the European population [88-90].