In a multicenter European study of 634 patients with biopsy-proven NAFLD, the aspartate aminotransferase (AST)-to-alanine aminotransferase (ALT) ratio, NAFLD fibrosis score and Fibrosis-4 index performed poorly for the diagnosis of advanced fibrosis in those aged 35 years or below [69]. The gene discussed is GPT; the disease is metabolic dysfunction-associated steatotic liver disease.