In conclusion, this study identified four ribosomal protein genes (RPL35, RPS8, RPS3A, and MRPL16) as immune-cell-related biomarkers associated with NAFLD progression, which may help to better understand the role of immune-related genes and cells in the pathogenesis of NAFLD and to develop novel diagnostic and therapeutic strategies. This evidence concerns the gene RPS3A and metabolic dysfunction-associated steatotic liver disease.