A recent study in the UK investigated 1118 patients with elevated liver enzymes in primary care; in those with suspected NAFLD, 7.6% were found to have significant disease based on an elevated NAFLD fibrosis score.3 An important finding from our study is that normal ALT levels, within the local laboratory range, were found in 72% of patients with elevated liver stiffness and 91% of patients with cirrhosis. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.