INS and metabolic dysfunction-associated steatohepatitis: However, patients with NASH and advanced fibrosis have frequently abnormally elevated ALT [46], and ALT serum levels have been found to be positively correlated with NAFLD activity score (NAS), liver triglyceride content, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and fasting insulin, making it a good predictor of NAFLD [47].