Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is a growing global health concern. Early and accurate Mash Diagnosis is crucial for effective management and preventing progression to more severe liver conditions. The American Association of Clinical Endocrinology (AACE) provides evidence-based guidelines to assist healthcare professionals in the diagnosis of MASLD. This guide summarizes key recommendations for mash diagnosis in adults, drawing from the AACE’s expert consensus.
Identifying High-Risk Individuals for MASH Diagnosis
Who should be prioritized for mash diagnosis? According to AACE guidelines, individuals exhibiting specific risk factors should be considered for screening. These high-risk groups include:
- Obesity and Metabolic Syndrome: Patients with obesity, especially when coupled with features of metabolic syndrome (like hypertension, dyslipidemia, and insulin resistance), are at increased risk.
- Prediabetes or Type 2 Diabetes (T2D): Dysglycemia significantly elevates MASLD risk. Individuals with prediabetes or established T2D should undergo assessment for liver disease.
- Hepatic Steatosis or Elevated Liver Enzymes: The presence of hepatic steatosis on imaging or persistently elevated plasma aminotransferase levels (ALT or AST) over six months are strong indicators for further mash diagnosis evaluation.
For patients undergoing bariatric surgery, the guidelines recommend evaluating for Metabolic dysfunction-associated steatohepatitis (MASH) and considering liver biopsy, particularly if pre-surgical risk stratification suggests indeterminate or high fibrosis risk.
Blood Tests for MASH Diagnosis and Fibrosis Assessment
Blood-based biomarkers play a vital role in the initial mash diagnosis process. The AACE recommends utilizing liver fibrosis prediction calculations to assess the likelihood of clinically significant fibrosis in MASLD.
- FIB-4 Index: The preferred initial non-invasive test is the FIB-4 (Fibrosis-4) index. This readily available and cost-effective calculation uses age, AST, ALT, and platelet count to stratify fibrosis risk.
For individuals in high-risk groups with indeterminate or high FIB-4 scores, further investigation is warranted. The guidelines suggest utilizing:
- Liver Stiffness Measurement (LSM) by Transient Elastography (VCTE): VCTE is a non-invasive imaging technique that measures liver stiffness, a surrogate marker for fibrosis.
- Enhanced Liver Fibrosis (ELF™) Test: ELF is a proprietary blood test that combines multiple serum biomarkers to assess fibrosis severity.
Imaging Studies in MASH Diagnosis
Imaging modalities are essential for staging fibrosis risk in individuals with MASLD. The AACE guidelines highlight Vibration-Controlled Transient Elastography (VCTE) as the preferred imaging method.
- Vibration-Controlled Transient Elastography (VCTE): VCTE is well-validated for identifying advanced fibrosis and predicting liver-related outcomes in MASLD.
Alternative imaging approaches can be considered based on availability and clinical context:
- Shear Wave Elastography (SWE): While less extensively validated than VCTE, SWE can also assess liver stiffness.
- Magnetic Resonance Elastography (MRE): MRE is considered the most accurate imaging technique for fibrosis assessment but is more expensive and less widely accessible. It is best utilized when ordered by a liver specialist in select cases.
MASH Diagnosis Screening in Diabetes
Given the strong association between diabetes and MASLD, the AACE provides specific recommendations for screening in diabetic populations.
- Type 2 Diabetes (T2D): Screening for clinically significant fibrosis using FIB-4 is recommended in all individuals with T2D, even those with normal liver enzyme levels.
- Type 1 Diabetes (T1D): Screening for MASLD with FIB-4 may be considered in T1D patients only if additional risk factors are present, such as obesity, metabolic syndrome features, elevated liver enzymes, or hepatic steatosis on imaging.
For both T1D and T2D patients with risk factors or elevated liver enzymes, further risk stratification using FIB-4, elastography, and/or ELF™ test is recommended.
Referral to Specialist for MASH Diagnosis Management
When should a patient be referred to a gastroenterologist or hepatologist for specialized care? The AACE guidelines provide clear referral criteria based on risk stratification from blood tests and imaging:
- Indeterminate or High Risk: Individuals with persistently elevated ALT or AST levels and/or hepatic steatosis on imaging who have indeterminate risk (FIB-4 1.3-2.67; LSM 8-12 kPa; or ELF™ test 7.7-9.8) or high risk (FIB-4 >2.67; LSM >12 kPa; or ELF™ test >9.8) should be referred.
- Clinical Evidence of Advanced Liver Disease: Patients exhibiting clinical signs of advanced liver disease, such as ascites, hepatic encephalopathy, esophageal varices, or hepatic synthetic dysfunction, require immediate referral to a specialist.
These guidelines from the AACE offer a structured approach to mash diagnosis, ensuring that at-risk individuals are identified and appropriately managed. For a comprehensive understanding of all recommendations, refer to the full guidelines available on the AACE website.
