PNPLA3 and metabolic dysfunction-associated steatohepatitis: Moreover, the homozygosity for PNPLA3 risk allele has been associated with more than 2-fold greater risk to develop NASH and cirrhosis, with up to a 12-fold increased risk for HCC and with an 18-fold increase in liver-related mortality (5, 6), thus suggesting a dose-dependent allele risk.