The AST to ALT has been shown to reflect disease severity in a number of chronic liver diseases, including alcoholic and non-alcoholic liver disease,7 autoimmune liver disease8 and hepatitis C.9 Previous studies10–14 have demonstrated that CVD is the leading cause of death in non-alcoholic fatty liver disease (NAFLD), with higher rates coinciding with higher liver-related mortality over follow-up periods from 10 to 20 years. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.