Formerly termed Non-Alcoholic Fatty Liver Disease (NAFLD), Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) affects more than 30% of the global adult population. Hepatic steatosis is both a consequence and an accelerator of systemic insulin resistance, carrying significant risks of progressive fibrosis, cirrhosis, and cardiovascular morbidity.
Non-Invasive Fibrosis Assessment: The FIB-4 Index
Primary care stratification relies on the FIB-4 index, calculated from routine lab values:
FIB-4 = (Age [years] × AST [U/L]) / (Platelet Count [10⁹/L] × √ALT [U/L])- FIB-4 < 1.30 (< 2.0 if age > 65): High negative predictive value for advanced fibrosis (F3–F4); manage in primary care.
- FIB-4 1.30 – 2.67: Indeterminate risk; secondary evaluation via transient elastography (FibroScan) or VCTE recommended.
- FIB-4 > 2.67: High probability of advanced fibrosis; warrants prompt hepatology referral.