Such trends were not observed in aspartate aminotransferase and γ-glutamyl transferase.<h4>Conclusions</h4>The uncommon combination of low ALT and fatty liver may be associated with high CCI, and older and more often women with the aspects of frailty, which was disclosed by the consideration of fatty liver, suggesting a phenomenon related to obesity paradox. This evidence concerns the gene GPT and obesity due to melanocortin 4 receptor deficiency.