It is noteworthy that our study did not find any causal associations between genetically predicted NAFLD and serum SHBG or bioavailable testosterone levels after adjusting for obesity and glycemic-related traits, which was inconsistent with observations from some previous studies suggesting that NAFLD patients were more likely to have lower serum SHBG levels [55, 56]. This evidence concerns the gene SHBG and metabolic dysfunction-associated steatotic liver disease.