INS and metabolic dysfunction-associated steatotic liver disease: In theliterature, another study showed the opposite: obese boys with NAFLD had higher ALTvalues than obese girls.24 Therefore, largecohort studies are needed to define gender differences in ALT in obese adolescents.Despite the controversy, the results suggest that sex hormones have a role in themanifestation of insulin resistance, beyond distribution of fat, muscle and bindingglobulin produced in the liver, which are strongly correlated with insulin sensitivityand the differences between ALT serum concentrations by gender.24