Liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are routinely used by primary care providers (PCP) to identify those likely to have MASH or MASH fibrosis/ cirrhosis (or HCC), but those measures have low sensitivity (i.e., true positive rate) and specificity (i.e., true negative rate), and those with normal ALT levels can span the range of disease severity in MASLD/ MASH (with or without fibrosis/cirrhosis) [3,4]. This evidence concerns the gene GPT and fibrosis.