The increase in ALT and GGT, indicating hepatic fat accumulation, leads to higher concentrations of very low density lipoprotein (VLDL) particles in the circulation, which may lead to hypertriglyceridemia and lower HDL cholesterol.30 This is consistent with our observed unfavourable trajectories in triglycerides and HDL cholesterol that occurred concurrently with unfavourable trajectories in ALT and GGT among participants with incident T2D. Here, GPT is linked to hypertriglyceridemia.