GPT and metabolic dysfunction-associated steatotic liver disease: Several limitations are also noteworthy: (i) the conclusions of this study are only applicable to the Chinese population, and the ALT/AST ratio and NAFLD risk were different by sex and age; (ii) although ultrasound has high accuracy in screening for NAFLD, it is still not comparable to the gold standard liver biopsy, which may mean that the true incidence of NAFLD was be underestimated; and (iii) as with other observational studies, this research could not eliminate confounding factors that actually exist but could not be measured.