Screening for liver disease should be conducted annually among patients with obesity, dyslipidemia, polycystic ovary syndrome (PCOS), and/or T2D.146,147 Measurement of alanine transaminase (ALT) and aspartate transaminase (AST) is recommended, with the caveat that these tests lack sensitivity in detecting early fatty liver disease, which may be present even if results are normal, especially in individuals with insulin resistance.148,149 Standard ultrasonography can determine hepatic fat content but is not a good means of determining the presence or degree of hepatic fibrosis. This evidence concerns the gene GPT and obesity due to melanocortin 4 receptor deficiency.