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We appreciate Dr. Khalid and colleagues’ interest in our study.[1] We acknowledge the limitations highlighted by them, underscoring the inherent challenges in using ultrasound and noninvasive methods for accurate fatty liver and fibrosis assessment. Due to the retrospective design of our study, incorporating other, more accurate noninvasive methods, such as quantitative ultrasound with computer-assisted hepatic/renal ratios, hepatic attenuation rate, or MRI-derived proton-density-fat-fraction, was not feasible, necessitating further research with robust diagnostic tools.

For fibrosis assessment, we employed specific cutoff values for the fibrosis-4 (FIB-4) index to categorize individuals into low (FIB-4< 1.30), intermediate (FIB-4 1.30–2.67), and high (FIB-4≥ 2.67) probability of advanced fibrosis, as applied.[2] The threshold for high probability of advanced fibrosis coincides with the cutoff value of≥ 2.67 suggested by …