Although we cannot confirm the clinical relevance of these findings in the HELIX study, a previous study of 201 children aged approximately 10 years with biopsy-proven NAFLD49 reported a 70% increase in odds of having nonalcoholic steatohepatitis for every 10-U/L increase in plasma CK-18. This evidence concerns the gene KRT18 and metabolic dysfunction-associated steatohepatitis.