In addition to the association of T2DM to NAFLD and NASH, evidence supports that raised HbA1c in T2DM indicates abnormal glucose tolerance, which may be one of the key factors contributing to the hepatic alterations manifesting in biopsy-proven NAFLD together with increased ALT in patients of metabolic syndrome (T2DM, central obesity, dyslipidemia, and hypertension)13. This evidence concerns the gene GPT and metabolic dysfunction-associated steatohepatitis.