Studies in Sweden and China indicate that lean NAFLD patients have higher incidence of cirrhotic liver changes and decompensated liver disease, leading to increased liver-related mortality.28,35 This difference may be genetic, and more specifically, linked to the patatin-like phospholipase domain-containing 3 (PNPLA3) genotype. The gene discussed is PNPLA3; the disease is metabolic dysfunction-associated steatotic liver disease.