24 - Noninvasive biomarkers for MASLD: FIB4 and ELF (16 min)

One in three adults worldwide are affected by fatty liver disease, and most are unaware that they have it. Today’s conversation between Andrew Hunt and Maeson Latsko, PhD will dive into Metabolic Associated Steatotic Liver Disease (MASLD), a new terminology that replaces NAFLD, emphasizing the close relationship with metabolic risk factors like obesity, diabetes, and dyslipidemia. We focus on the importance of identifying patients at risk for advanced fibrosis early—before irreversible liver damage occurs. A key tool in this early identification is the use of a fibrosis 4 (FIB-4) score, which is a noninvasive blood-based biomarker that uses age, AST, ALT, and platelet count to estimate fibrosis risk and guide next steps in management. We discuss follow-up testing for some at-risk patients using the Enhanced Liver Fibrosis (ELF) test and the need for continued monitoring  of comorbid cardiometabolic conditions. This episode will Explain the shift in terminology from NAFLD to MASLD (4:00) Highlight the importance of early identification of fatty liver disease using the FIB-4 score (5:45) Outline appropriate follow-up testing, including the use of the ELF test to assess liver fibrosis (9:00) Explore the link between MASLD and other cardiometabolic conditions (12:10)   To learn more, please review the additional resources below for information on our cardiovascular, metabolic, endocrine, and wellness offerings as well as educational resources and insights from our team of experts. At Quest Diagnostics, we are committed to providing you with results and insights to support your clinical decisions. Date: 10/2025 Speaker(s):  Andrew Hunt; Maeson Latsko, PhD Contributor(s): Maeson Latsko, PhD; Andrew Hunt; Trisha Winchester, PhD, Millicent Kee, MSN, FNP-BC     Additional Resources   Quest Diagnostics Clinical Education Center [Link]  ELF test detail  FIB4 test summary  2022 AACE algorithm for fatty liver assessment   Ordering information:  CMP + Fib4  Enhanced Liver Fibrosis Score    References:   Ciardullo S, Vergani M, Perseghin G. Nonalcoholic fatty liver disease in patients with type 2 diabetes: Screening, diagnosis, and treatment. J Clin Med. 2023;12(17):5597. doi:10.3390/jcm12175597  Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. doi:10.1097/HEP.0000000000000323  Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28(5):528-562. doi:10.1016/j.eprac.2022.03.010  Stern C, Castera L. Identification of high-risk subjects in nonalcoholic fatty liver disease. Clin Mol Hepatol. 2023;29(Suppl):S196-S206. doi:10.3350/cmh.2022.0431