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➤ Screening
• The 2023 AASLD Practice Guidance recommend screening
individuals with obesity for MASLD through clinical assessment
and liver enzyme tests (ALT, AST); however, normal f indings do
not exclude steatosis, and non-invasive imaging (ultrasonography,
computed tomography [CT], or magnetic resonance imaging
[MRI]) may be required to detect hepatic fat. Advanced f ibrosis is
assessed using tools such as the MASLD Fibrosis Score, f ibrosis-4
(FIB-4) index, or elastography, which aid in risk stratif ication and
referral for liver biopsy, the def initive method for diagnosing
metabolic dysfunction-associated steatohepatitis (MASH) and
staging f ibrosis.
➤ Diagnosis
• MASLD is defined by the presence of hepatic steatosis in
conjunction with at least one metabolic risk factor, including:
▶ Waist circumference (≥94 cm in men, ≥80 cm in women
[or ethnicity adjusted equivalent])
▶ Alcohol consumption below harmful thresholds (20 g/day
women, 30 g/day for men)
▶ Blood pressure ≥130/85 mm Hg or use of antihypertensive
medication
▶ Fasting glucose ≥100 mg/dL, HgbA1C ≥5.7 , 2-hour glucose
≥140 mg/dl during oral glucose tolerance test or use of glucose
lowering medications
▶ Triglycerides ≥150 mg/dL or lipid-lowering therapy
▶ Reduced HDL cholesterol (<40 mg/dL for men and <50 mg/dL
for women) or use of lipid-lowering medication.
• Although liver biopsy is the gold standard for diagnosis, it is
typically reserved for cases when noninvasive assessments are
inconclusive or when MASH is suspected.
