Additionally, as shown in Fig. 1, an increase in ALT in ADG users was more noticeable in patients with NAFLD than in patients without NAFLD, supporting previous research that NAFLD patients may be at risk of developing DILI. Nonetheless, we also concerned that ALT elevation in our patients could be from various conditions, therefore, we had excluded patients with known cause of ALT elevation such as tumor progression or flare of viral or autoimmune hepatitis, and patients reported to have other herbal or dietary supplements rather than ADG prior to the analyses of ALT change. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.