While a FAST score of ≥ 0.35 is considered the cutoff value for advanced fibrosis in NASH, multivariate analysis adjusted for cardiovascular metabolic risk factors revealed that the GG genotype of PNPLA3 rs738409 and rs2896019 remained a significant risk factor for FAST score > 0.35 in this study. Here, PNPLA3 is linked to metabolic dysfunction-associated steatohepatitis.