The combination of consistently higher serum cholesterol and higher biomarkers of liver damage such as aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), and especially ALT is suggests a toxicant-induced nonalcoholic fatty liver disease (NAFLD) mechanism for PFAS hepatoxicity [8,17,18,19,20,21,22,23]. The gene discussed is GPT; the disease is metabolic dysfunction-associated steatotic liver disease.