Even if it is not clear yet where the process begins, visceral adiposity certainly plays a key role in initiating IR and subsequent liver injury, even in the absence of increased BMI or an overt diagnosis of diabetes or metabolic syndrome, also conferring an increased risk of NAFLD, especially in PNPLA3 carriers [20,121]. This evidence concerns the gene PNPLA3 and metabolic dysfunction-associated steatotic liver disease.