Meanwhile, after being graded by both sex and puberty, ALT (male and prepuberty: OR, 1.055; 95% CI, 1.038–1.073; p < 0.001; male and early puberty: OR, 1.078; 95% CI, 1.056–1.100; p < 0.001; female and early puberty: OR, 1.093; 95% CI, 1.039–1.150; p < 0.001) remained an independent risk factor for NAFLD, except in prepuberty female children. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.