Kleiner et al demonstrated that a change of 10 U/L in liver enzymes (ALT and AST) was associated with a clinically significant change in liver fibrosis score in an adult population with biopsy-proven NAFLD, borderline NASH, and definitive NASH.46 Others have demonstrated that a 30% reduction in ALT is associated with improved histological features of NASH.48,49 The mean difference in ALT of 11.81 U/L may be clinically significant. This evidence concerns the gene GPT and metabolic dysfunction-associated steatotic liver disease.