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We read with interest the study by Tica et al and commend the authors for their giving insights from an extensive cohort.1 However, the paper appears to over-attribute steatosis in a 24-year-old to developmental or preconception influences, when the more plausible dominant explanation is the shared familial metabolic milieu across childhood, adolescence and early adulthood. The intrauterine contribution, if present, is likely to be only one part of a larger and more complex picture.2