The TONIC trial, which evaluated therapeutic intervention with vitamin E vs. metformin in children with NAFLD, showed that both improved hepatocellular ballooning and the NAFLD activity score (NAS), but neither vitamin E nor metformin decreased alanine aminotransferase (ALT) values or hepatic steatosis, inflammation, or fibrosis in NASH. This evidence concerns the gene GPT and metabolic dysfunction-associated steatotic liver disease.