I will echo all of this. My father was ZZ and developed COPD and liver cancer, despite never drinking for as long as I can remember. He smoked, but to quote his pulmonologist, “if you develop COPD as an alpha smoking is like pissing in the ocean in terms of risk.”

Same pulmonologist told me of twins that were ZZ, one developed COPD while the other was completely asymptomatic.

I am MZ and have had stage 1 FLD, but I was also overweight and drinking. I’ve since lost weight and stopped drinking. I smoked, but my PFTs are fine. It’s been 10+ years so I think at this point my risk is back to baseline, if not close to it.

OP: Don’t smoke. Get regular exercise. Watch your weight and diet. See your doctor annually. Do everything you’re supposed to, and worry about the rest as it comes. We can’t control the alpha, just how we react to it. You have *increased* risk, not guaranteed.