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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
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
View all episodes
By Quest DiagnosticsOne 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
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