Another study of the Michigan Genomics Initiative and UK Biobank participants with elevated ALT found that in low FIB4 individuals, genetics were weakly or not associated with incident severe liver disease, but individuals with intermediate FIB4 but high-risk genetics (PNPLA3-rs738409-GG genotype) and cardiometabolic disease (diabetes) had risk comparable to that of high FIB4 individuals (70). This evidence concerns the gene PNPLA3 and diabetes mellitus.