One study reported no significant association after adjustment for confounders, and one case-control study identified a modest U-shaped relationship, with moderate PRAL levels inversely associated with NAFLD odds (adjusted OR ≈fsn371597-bib-00180.46; 95% CI, 0.24-0.89), while higher PRAL levels were not significantly associated. This evidence concerns the gene PRAL and metabolic dysfunction-associated steatotic liver disease.