We hypothesized that the AAR is not suitable for assessing liver fibrosis in participants with non-MAFLD or mild MAFLD because in non-MAFLD patients without fatty liver, AAR was > 1 in 86.5% (5,071/5,865) of participants with normal ALT (< 30 IU/L in male patients and < 19 IU/L in female patients) and 49.3% (816/1,654) of patients with elevated ALT levels. Here, GPT is linked to Hepatic fibrosis.