Previous studies also supported the superiority of AST over ALT in detecting (advanced) fibrosis in NAFLD patients [22] and the limited value of ALT in predicting fibrosis [23], possibly due to frequently normal ALT values within the reference range even in patients with advanced NAFLD, or declining ALT with age [12, 24, 25]. Here, GPT is linked to metabolic dysfunction-associated steatotic liver disease.