GPT and malnutrition: Although they did not evaluate baseline BMI, they found that serum cholesterol levels, which usually show a positive relationship with BMI,27 were inversely associated with the incidence of HCC.26 Furthermore, malnutrition such as low BMI frequently occurs in patients with chronic liver disease such as liver cirrhosis, leading to an increase in mortality.28 These results might be consistent with our study findings, which identified significant increases in mortality and medical costs in participants with high serum ALT levels and low BMI.