The summarized proportion of NAFLD patients with normal ALT value in prospective cohort study group was 0.32 (95%CI: 0.22–0.43, I2 = 85.0%), which higher than in retrospective cohort study group 0.21 (95%CI: 0.10–0.28, I2 = 87.0%) and cross-sectional analysis group 0.27 (95%CI: 0.19–0.37, I2 = 85.0%). The gene discussed is GPT; the disease is metabolic dysfunction-associated steatotic liver disease.