Screening

Screening for metabolic dysfunction-associated steatotic liver (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH)

The European Association for the Study of the Liver, the UK National Institute for Health and Care Excellence, and the Asia-Pacific Working Party on MASLD recommend screening high-risk groups.[8][41][68][69]​ These are identified as individuals with obesity, metabolic syndrome, type 2 diabetes, and abnormal liver enzymes. The American Association for the Study of Liver Diseases advises against general population-based screening for MASLD but recommends screening high-risk groups for advanced fibrosis.[3]​ Proposed screening modalities include liver enzyme testing and ultrasonography. The presence of MASLD/MASH should be considered in patients who have risk factors for the development of the disease, including obesity, diabetes/insulin resistance, dyslipidaemia, or severe and rapid weight loss (especially in those who were obese initially).[24] MASLD should also be considered in the differential of elevated liver tests in those taking medications associated with MASLD. Finally, it should be considered in those with persistent elevations in liver enzymes for which no other cause can be ascertained.

In the US, the American Gastroenterological Association recommends that patients with suspected MASLD be questioned carefully about alcohol use. The initial laboratory evaluation should include alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, serum bilirubin, and albumin levels; a prothrombin time; and diagnostic tests for viral hepatitis. When alcohol use and other causes of liver disease are excluded by clinical and laboratory evaluation, an imaging study (e.g., ultrasonography or computed tomography) should be performed.[37] Those patients deemed to be at high risk for advanced fibrosis or cirrhosis should be referred to a hepatologist for further assessment.[51]

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