The strengths of the study are as follows: a longitudinal cohort design with a relatively large sample size was used, which allowed for more convincing conclusions; more accurate statistical methods, GEE methods, was used to improve the credibility of the conclusion; adjustment for Hb concentration was conducted for a rational evaluation of the independent effects of RBC count on NAFLD; and more detailed research content, including classification of NAFLD degree and NAFLD progression assessment, was used to obtain more comprehensive conclusions. Here, GSTM1 is linked to metabolic dysfunction-associated steatotic liver disease.