GPT and metabolic dysfunction-associated steatotic liver disease: In the present study, no association between ALT levels and AST/ALT ratio with IFG were found, however, Fracanzani et al. [24] previously reported a significant association between diabetes with severe liver disease in adult patients with NAFLD with elevated ALT, but also HOMA-IR in patients with normal ALT, in spite that Manco et al. [25] stated that prevalence of MetS is similar between patients with normal and abnormal ALT values, and that normal ALT values cannot exclude evidence of liver steatosis.