Our findings were in accordance with other studies in the literature, indicating that the Pi*Z allele could be considered a disease modifier for liver disease and stiffness among individuals with obesity and diabetes mellitus [30,31], as well as a risk factor for cirrhosis development in patients with non-alcoholic fatty liver disease (NAFLD) and alcohol misuse [32]. This evidence concerns the gene SERPINA1 and metabolic dysfunction-associated steatotic liver disease.