Alcohol-producingKlebsiella pneumoniae(found in up to 60% of MASLD patients) can induce MASLD in mice.53In contrast, Engstler et al178suggested that the elevated plasma ethanol in children with MASLD relative to healthy controls are associated closely with obesity indices and insulin resistance, not gut bacterial overgrowth. The gene discussed is INS; the disease is metabolic dysfunction-associated steatotic liver disease.