Metabolic dysfunction-associated steatotic liver disease (MASLD): look for advanced fibrosis

Fasting laboratory tests

• AST
• ALT
• FBC with platelets
• Fasting plasma glucose
• Lipid profile
• HbA1c (if fasting plasma glucose ≥ 1.26 g/L)if neededFasting plasma glucose ≥ 1.26 g/L: diabetes, HbA1c and diabetes management (grade A1) ^[1].
• Serum ferritinif neededA ferritin > 1 000 µg/L or a transferrin saturation > 45% leads to looking for a disease other than metabolic steatotic liver disease ^[1]. Cytolysis: aetiological work-up of the page "Raised transaminases".
• Transferrin saturationif neededA ferritin > 1 000 µg/L or a transferrin saturation > 45% leads to looking for a disease other than metabolic steatotic liver disease ^[1]. Cytolysis: aetiological work-up of the page "Raised transaminases".
• Serum creatinine with GFRif needednon-French guidelineLooking for associated kidney disease: creatinine, albuminuria and GFR are among the tests for comorbidities, at diagnosis and at follow-up ^[2]. Diabetic patient: see the page "Type 2 diabetes".
• Urine albumin:creatinine ratioif needednon-French guidelineLooking for associated kidney disease: creatinine, albuminuria and GFR are among the tests for comorbidities, at diagnosis and at follow-up ^[2]. Diabetic patient: see the page "Type 2 diabetes".
• Calculate the FIB-4 = age (years) × AST (IU/L) / [platelets (G/L) × √ALT (IU/L)].

Second step, if FIB-4 ≥ 1.30 (≥ 2.0 after age 65)

• Liver elastography (FibroScan or ultrasound elastography) as first option (not a laboratory test).
• FibroTest or FibroMeter (if elastography is not available)if neededSpecialised blood marker, second line, as an alternative to elastometry, if FIB-4 does not exclude advanced fibrosis ^[1].

Every 1 to 3 years (see the note)

• AST
• ALT
• FBC with platelets (new FIB-4)

Every year in prediabetes

• Fasting plasma glucoseif neededPrediabetes (fasting plasma glucose between 1.10 and 1.26 g/L): annual check of fasting plasma glucose ^[1].