We read with great interest the recently published article by Leach et al. [1]. In this study, it was aimed to evaluate serum homocysteine (Hcy) levels and oxidative stress status in patients with biopsy-proven non-alcoholic steatohepatitis (NASH) and to check their possible association with cardiovascular risk measured by carotid artery intima-media thickness (c-IMT). In conclusion, NASH was determined to be associated with elevated Hcy levels, oxidative stress and c-IMT. Moreover, mild Hcy levels were claimed to be the result of an altered transsulfuration pathway due to liver dysfunction.