The most recent TONIC study [a large, multicenter RCT evaluating the effect of a 2 year therapy with Vitamin E (400 IU twice daily) or insulin sensitizer metformin (500 mg twice daily) or placebo in 173 children with biopsy-confirmed NAFLD] substantiated its scarce effectiveness in lowering serum ALT, with only marginal effects on hepatic histology[23]. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.