PNPLA3 and obesity due to melanocortin 4 receptor deficiency: The PNPLA3 SNP rs738409, the second strongest signal in our study, has been extensively linked to hepatic steatosis, steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma across diverse populations,[28], [29], [30] particularly in individuals with obesity.[31], [32], [33], [34], [35] The variant was also identified in the GWAS by Sun et al.24 (p = 8.6x10-13), suggesting a broader role in hepatic fat accumulation beyond obesity-related steatotic liver disease and independent of adiposity.