(i) A higher ALT/AST ratio has been associated with hepatic fat infiltration and hepatic steatosis [20, 21]; (ii) in the Asian population, the ALT/AST ratio was considered to be a reliable marker of insulin resistance (IR) [37, 38, 42], while IR was a key pathophysiological factor for NAFLD [43]; and (iii) a higher ALT/AST ratio is closely related to inflammation in the liver [24], and chronic inflammation could further induce steatosis and IR in the liver [1, 24]. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.