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We commend Natarajan et.al. (1) on their work regarding differences in cirrhosis and hepatocellular carcinoma (HCC) risk in patients with non-alcoholic fatty liver disease (NAFLD) with or without persistent alanine transferase (ALT) elevations. The study is timely and addresses an important question regarding the prognostication of liver-related outcomes in NAFLD.In the third of a series of studies and reports, the authors expand on the frequency occurrence proportions of various handwritten features. The first study culminated in the pu