On the other hand ALT > 45 IU/l was considered abnormal in boys and > 34 IU/l in girls; only 3 patients had increased level (4.1% of the total number of cases and they represented only 6.5% of the NAFLD cases) this agrees with the opinion that normal liver enzymes do not exclude fatty liver [39], and further suggests that serum liver enzymes are good indicators for NAFLD diagnosis, however, ‘‘normal’’ standard levels used for exclusion of NAFLD are needed to be reviewed. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.