We have read with interest the study from Simon et al, where the authors observed a higher mortality rate among patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) compared with reference controls without NAFLD.1 Importantly, mortality rates exhibited a significant increase as the severity of NAFLD worsened, that is, from simple steatosis, non-fibrotic nonalcoholic steatohepatitis (NASH), non-cirrhotic fibrosis (ie, F1–F3, with or without NASH) to cirrhosis. The leading causes of death were attributable to extrahepatic cancers and liver cirrhosis, while cardiovascular disease and hepatocellular carcinoma had a comparatively lesser impact. This extensive study of patients with NAFLD reveals higher mortality rates across different NAFLD stages but does not stratify causes of death within the respective pre-cirrhotic fibrosis stages (F0–F3). Owing to the long natural history of NAFLD, for example, patients with F0 and F1 may never experience liver-related events.2–4 For that reason, to assess the distribution of causes of death based on fibrosis stage, we retrospectively leveraged the granular data from a cohort of 959 patients …