Another limitation is that our study included a cohort of Italian NAFLD patients referred to a tertiary referral center, largely obese, with abnormal ALT levels, and at high prevalence of NASH and severe fibrosis, who may be different, in terms of metabolic features, ALT levels and severity of liver disease, from the majority of prevalent cases of NAFLD in the general population”. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.