GPT and Insulin resistance: Attention must be given to the onset of other viral infections, acute increase in ALT, symptoms of more advanced liver disease [74], degree of obesity, ethnicity (Hispanic children [75]), or comorbid conditions contributing to the onset or progression of MASLD, namely, obstructive sleep apnea (OSA), hypothyroidism, depression or anxiety, use of alcohol and drugs, or family history of metabolic, autoimmune liver diseases, other chronic liver diseases, insulin resistance, or T2DM (see below).