It can be observed when the ALT/AST ratio increased by 1, the risk of NAFLD increased by 2.61 times (aHRs: 2.61, 95% CI: 2.48, 2.76), and the increasing trend between the quintile of the ALT/AST ratio and NAFLD risk remained unchanged (P for trend< 0.001). The gene discussed is GPT; the disease is metabolic dysfunction-associated steatotic liver disease.