North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines recommend liver biopsy for patients at high risk of MASH and advanced fibrosis, such as those with ALT levels greater than 80 U/L, splenomegaly, or an aspartate aminotransferase (AST)-to-ALT ratio above 1 [104,117]. This evidence concerns the gene GPT and fibrosis.