Our study revealed (i) an increased risk of elevated ALT in pwMS relative to general population, only a third of which could be explained by NAFLD; (ii) the rate of elevated ALT in pwMS with NAFLD is comparable to that of general population; and (iii) a negative association between measures of disability accrual and span of spleen, which was independent from age, sex, MS duration and DMTs, and the underlying reason for which remains to be investigated. The gene discussed is GPT; the disease is metabolic dysfunction-associated steatotic liver disease.