Clinically, fatty liver is often diagnosed with the elevation of both ALT and AST, which agrees with studies that showed NAFLD, ALT, AST and ALP are all independent predictors for incident diabetes in humans, and further that serum ALP may be an independent biomarker of liver fibrosis in obese patients with NAFLD [24,25]. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.