Various studies have documented that the whole histological picture of NAFLD can be appreciated in patients with normal levels of ALT.6 Raised levels of serum ALT and AST might be present in NAFLD patients, though levels within normal do not eliminate the existence of NAFLD and NASH.7 When raised, these patients mostly have serum AST to ALT ratios of less than 1, distinct to the alcoholic liver disease in which specifically the ratios are greater indicating that there is no alteration in the degree of advanced fibrosis among normal and the group with raised ALT levels. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.