Stender et al. [178] suggest that the effects of all of these three sequence variants (PNPLA3 p.I148M, TM6SF2 p.E167K, and GCKR p.P446L) are amplified by the presence of adiposity, which further promotes the deterioration towards NASH and cirrhosis. This evidence concerns the gene PNPLA3 and metabolic dysfunction-associated steatohepatitis.