Moreover, in a study using direct flow injection electrospray ionization tandem mass spectrometry (ESI–MS/MS), saturated ceramide-enriched liver lipidome was observed in those with NASH in the context of metabolic syndrome and insulin resistance, but not in those with “genetic-driven”, PNPLA3-associated NASH, i.e., those carrying I148M variant of the gene [79]. Here, PNPLA3 is linked to metabolic dysfunction-associated steatohepatitis.