A 66-year-old, male patient with a BMI of 33 kg/m² is referred to the Hepatology outpatient clinic by his GP due to elevated serum transaminases (ALT 60 U/L, AST 58 U/L). At the outpatient clinic the calculated FIB-4 score was 1.92 and HBsAg and anti HCV were negative. An abdominal ultrasound was compatible with liver steatosis. To further investigate the risk of underlying liver fibrosis, transient elastography was performed and a liver stiffness of 9 kPa was objectified. A subsequent liver biopsy revealed NAFLD with F2 fibrosis. A PNPLA3 p.I148M mutation analysis was positive.