Role of Non-invasive Biomarkers in the Evaluation and Management of MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD),¹ refers to a range of liver conditions characterized by the accumulation of fat in the liver due to metabolic factors. MASLD affects nearly 30% of the global population and is a prevalent cause of advanced liver disease.² This disease can progress from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH), which involves inflammation and liver cell damage—and unmitigated can lead to liver cirrhosis, liver failure, and liver cancer.

Clinicians' early identification and stratification of at-risk individuals may impact progression and regression, as only a minority of individuals with MASLD present with liver-related consequences.² Although early identification and risk stratification may occur in gastroenterology and hepatology clinics, disease modifying interventions may occur outside of those settings. Continuously monitoring MASLD response to current treatments is also key. Histologic examination of the liver is the current established standard for assessing and monitoring this disease, grading necroinflammation, and staging hepatic fibrosis; however, the cost and invasiveness limit its routine and widespread use.² Drug approvals independent of histology-based outcomes lay the groundwork for further standardization and validation of noninvasive tests (NITs) in the evaluation and management of MASLD. The latest AGA Clinical Practice Update (2023) can help healthcare professionals use NITs to identify patients who are at higher risk for MASLD progression for directed intervention.² Ongoing research continues to refine the use of NITs in evaluating and managing MASLD; therefore, the landscape is likely to evolve and advance over time.

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