It is well established that the polymorphism rs738409 of PNPLA3 increases the susceptibility to develop NAFL, NASH, liver fibrosis, ALD, and HCC.4,5 The risk allele was also significantly overrepresented in patients with HCC in the cohort analyzed in this study (Figure 5A, see also15). This evidence concerns the gene PNPLA3 and metabolic dysfunction-associated steatohepatitis.