Podcast Summary: Healthier World with Quest Diagnostics

Episode: Instant Insights: Decoding MASLD

Host: Dr. Mason Latsko (on behalf of Quest Diagnostics)
Date: October 6, 2025
Duration: 7 minutes

Episode Overview

This “Instant Insights” mini-episode presents a concise, high-impact exploration of MASLD—Metabolic Dysfunction Associated Steatotic Liver Disease, formerly known as NAFLD. Dr. Mason Latsko explains the rationale behind the new terminology, provides a quick clinical primer on disease progression, and offers actionable strategies for early detection and risk stratification using the FIB4 and ELF scoring tools. The episode underscores the importance of early identification—not only for liver health but for broader cardiometabolic risk management.

Key Discussion Points & Insights

1. Reframing Fatty Liver Disease

• Old Term: NAFLD (Non-Alcoholic Fatty Liver Disease)
• New Term: MASLD (Metabolic Dysfunction Associated Steatotic Liver Disease)
  • Reason for Change:
    • Focuses on metabolic risk factors (e.g., insulin resistance, type 2 diabetes, obesity, dyslipidemia).
    • Reduces stigma.
    • Aligns with cardiometabolic comorbidities.
    • Improves clarity in clinical communication.
    • [01:05] “An international group of liver experts now recommends the name MASLD... the name change reduces stigma, improves clarity, and better aligns with cardiometabolic comorbidities.”

2. Disease Progression Model of MASLD

• Steatosis: Initial accumulation of fat in liver cells.
• MASH (previously NASH): Onset of inflammation.
• Fibrosis: Formation of scar tissue as repair mechanism.
• Cirrhosis: Permanent, widespread scarring and impaired liver function.
• End-stage: Risk of hepatocellular carcinoma (liver cancer).
• [02:20] “The process of MASLD is slow and it might take decades for a disease to progress.”

3. Importance of Early Detection

• Vast majority of patients are asymptomatic until significant and irreversible damage occurs.
• Early stratification of patients is critical.
• [03:00] “Unfortunately, the majority of patients with MASLD don’t have symptoms until significant damage is already done. That’s why early stratification is so important.”

Diagnostic Tools and Screening Pathway

4. FIB4 Score (Fibrosis-4 Index)

• What it is: Non-invasive calculator using age, AST, ALT, and platelet count.
• Who should get it:
  • Those with prediabetes, type 2 diabetes, obesity, elevated liver enzymes, or >2 cardiometabolic risk factors.
• Interpretation:
  • < 1.3: Low risk – monitor in primary care.
  • 1.3 – 2.67: Indeterminate risk – requires further assessment.
  • > 2.67: High risk – likely advanced fibrosis.
• Clinical Utility:
  • Can be automatically added to a CMP panel through Quest Diagnostics.
  • High negative predictive value – best as a “rule out” tool.
• [03:57] “The FIB4 score can be easily calculated using an online calculator, or... can be added to a standard CMP through Quest Diagnostics.”
• Memorable Quote:
  • [04:32] “The FIB4 has a high negative predictive value and should be viewed as a rule out test given that this score will identify patients who are not at risk for liver fibrosis and cirrhosis.”

5. ELF Score (Enhanced Liver Fibrosis)

• Purpose: Secondary assessment for indeterminate or high-risk FIB4 scores.
• How it works:
  • Measures three serum proteins as biomarkers of fibrosis: hyaluronic acid, procollagen 3N terminal peptide, tissue inhibitor of metalloproteinase 1.
  • Offers prognosis for advanced fibrosis and risk of liver-related events.
  • Only FDA-indicated serum prognostic test for MASH and MASLD.
• Recommended by: AACE, ADA, AASLD.
• [05:13] “The ELF score is often used in place of a liver stiffness measurement done by elastography because it is the only FDA indicated serum test that can be used as a prognostic test for MASLD and MASH.”

6. Clinical Action Algorithm

• Step 1: Identify patients with metabolic risk factors (diabetes, obesity, dyslipidemia, elevated liver enzymes).
• Step 2: Order FIB4 score.
  • If low: Continue monitoring in primary care.
  • If >1.3: Proceed to ELF score.
• Step 3: Interpret ELF score:
  • High ELF: Consider specialist referral.
  • Intermediate ELF: Consider imaging and aggressive risk management.
  • Low ELF (<9.8): Continue monitoring and fibrosis risk assessment in primary care.
• [06:14] “If the ELF score is high, that’s when the results will suggest referral. If the ELF score is intermediate, those patients should consider imaging and aggressive risk management.”

Broader Implications

• Integration with Cardiometabolic Disease:

  • Identification of MASLD acts as a red flag for cardiovascular, metabolic, and renal disease.
  • Early detection can lead to meaningful intervention across organ systems.
  • [06:40] “If you screen for MASLD using the FIB4 and ELF, you’re not just protecting the liver; you’re identifying risk for heart failure, for atherosclerosis, for kidney damage, and most importantly, the metabolic root cause of MASLD.”

• Essential Risk Communication:

  • [07:00] “As we’ve said before on this podcast, identifying risk in one organ identifies risk in others, and early prevention can save a life.”

Notable Quotes & Memorable Moments

• [01:15] “The name change to MASLD focuses on what causes the disease—metabolic dysfunction, insulin resistance, type 2 diabetes, obesity, dyslipidemia...”
• [04:10] “The FIB4 score gives you the risk of having advanced fibrosis... and can easily be calculated or added to a routine lab panel.”
• [06:42] “Knowledge is power. Identification of MASLD should be used as a clinical red flag for cardiovascular, metabolic and renal disease.”

Quick Reference: Screening Workflow

| Step | Risk Factor/Score | Action | |------|------------------|------------------------| | 1 | Metabolic risks | Order FIB4 | | 2 | FIB4 < 1.3 | Monitor in primary care| | 3 | FIB4 > 1.3 | Order ELF score | | 4 | ELF High | Specialist referral | | 5 | ELF Intermediate | Imaging, risk management| | 6 | ELF Low (<9.8) | Monitor in primary care|

Final Takeaway

The transition from NAFLD to MASLD represents a shift from exclusion-based to cause-focused diagnosis, helping clinicians better identify, stratify, and act on risk—protecting not just liver health but the entire cardiometabolic profile of the patient. Early and systematic screening with FIB4 and ELF is crucial in practice.