Obesity exposes the association of PNPLA3 I148M to elevated hepatic fat levels and risk of NASH, with more pronounced impact of hepatic injury in obese individuals compared to lean individuals, and confers genetic susceptibility from a young age (Romeo et al., 2010a; Romeo et al., 2010b; Giudice et al., 2011; Palmer et al., 2012). This evidence concerns the gene PNPLA3 and metabolic dysfunction-associated steatohepatitis.