Podcast Summary: Healthier World with Quest Diagnostics
Episode: Noninvasive Biomarkers for MASLD: FIB4 and ELF
Date: October 20, 2025
Length: 16 minutes
Guests: Andy Hunt, Product Manager, Cardiometabolic, Endocrine, and Wellness, Quest Diagnostics
Host: Quest Diagnostics
Episode Overview
This episode explores the evolving understanding and diagnostic approach to Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD). The focus is on the importance of early detection using noninvasive biomarkers such as FIB4 and ELF, reflecting a major shift in both medical terminology and clinical practice standards. Andy Hunt discusses the central role of the liver, the rationale behind the current MASLD terminology, and how providers can use these screening tools to improve outcomes for patients with metabolic and cardiometabolic risk.
Key Discussion Points & Insights
1. The Essential Role of the Liver
- The liver is described as the “workhorse” of the body due to its roles in blood filtration, detoxification, nutrient/hormone metabolism, energy (glycogen) storage, and fat metabolism.
- Lifestyle (poor diet, alcohol, environmental toxins) and systemic metabolic dysfunction overwork the liver ([01:22]).
Quote:
“The liver, quite frankly, is really the workhorse of our body and it just doesn't really get enough love.”
— Andy Hunt [01:22]
- 1 in 3 adults globally have some form of fatty liver disease, most undiagnosed ([01:22]).
2. Shifting Terminology: NAFLD to MASLD
- The move from "nonalcoholic fatty liver disease" (NAFLD) to "metabolic dysfunction associated steatotic liver disease" (MASLD) is significant.
- This new term centers metabolic dysfunction—insulin resistance, obesity, type 2 diabetes, hypertension, and cardiovascular disease—as the foundational cause of liver disease ([04:04]).
Quote:
“It was known as nonalcoholic fatty liver disease... But recently it’s been changed to metabolic dysfunction associated steatotic liver disease. That’s really important... because it’s really some of our malfunctioning metabolic processes... that are really driving some of the fibrosis we’re starting to see in the liver.”
— Andy Hunt [04:04]
3. Importance of Early Risk Detection
- Early detection is vital as fibrosis progression can be slowed and even reversed with timely intervention ([05:07]).
- Behavioral changes have the most impact when applied before significant fibrosis occurs.
4. The FIB4 Score: First-Line Screening
- FIB4 is a noninvasive, cost-effective rule-out test built from standard bloodwork: AST, ALT, platelet count, and age ([05:49]).
- Widely available but underutilized, despite guidelines supporting its use for anyone with prediabetes, diabetes, obesity plus other risk factors, or elevated liver enzymes.
Quote:
“There's really no easier and cheaper tool than FIB4. It is really created from analytes commonly being ordered in every healthcare visit... But unfortunately, the utilization of the FIB4 test code is still so underutilized..."
— Andy Hunt [05:49]
- Anyone can use a free FIB4 calculator online with routine lab results ([06:45]).
5. FIB4: Decision Guidance for Providers
- Low risk (FIB4 < 1.3): Continue general management with a focus on lifestyle/comorbidity control in primary care ([08:07]).
Quote:
"Patients that are lower than 1.3... guidelines are currently recommending... a focus on managing obesity or cardiometabolic comorbidities..."
— Andy Hunt [08:07]
- Indeterminate or high risk (FIB4 ≥ 1.3): Move to second-line testing (elastography or ELF test; Quest offers ELF) ([08:24]).
6. The ELF Test: Enhanced Liver Fibrosis Blood Test
- Used for those in the indeterminate/high FIB4 range as a secondary, confirmatory test ([09:04]).
- Cost-effective, noninvasive, and FDA-indicated for MASLD and MASH prognosis.
Quote:
“The ELF score specifically is the only FDA indicated serum test being viewed as a prognostic marker for MASLD and MASH. It's really simply a proteomic marker... to predict the risk of advanced fibrosis.”
— Andy Hunt [09:04]
- Roughly 1 in 4 patients screened by FIB4 will need ELF as follow-up testing ([10:12]).
- Earlier, easier testing improves access, and reduces need for liver biopsy and associated costs.
7. Linking MASLD with Broader Cardiometabolic Risk
- MASLD reflects systemic issues—patients have 2–3X the risk of cardiovascular events and a twofold increased risk for CKD ([13:40]).
- Underlying mechanisms: insulin resistance, chronic inflammation, oxidative stress, endothelial dysfunction, atherogenic dyslipidemia.
Quote:
“MAST goes well beyond the liver. The shared pathophysiological mechanisms... contribute to both hepatic fibrogenesis and vascular injury.”
— Host [13:40]
- Even if follow-up ELF is low risk, underlying metabolic dysfunction should trigger further evaluation ([12:08]).
8. Wellness Biomarkers: Proactive Risk Assessment
- Wellness testing isn’t necessarily costly or complex—basic lipids, ApoB, hs-CRP, and insulin/inflammation panels can catch risk early ([14:23]).
- Early testing (even in 20s and 30s) can prevent late-stage disease onset.
Quote:
“It doesn't always have to be as complicated, as expensive... there’s simple tests like a lipid or ApoB... Because I think there is one thing all diseases have in common: the earlier you catch it, the better you have a chance to do something about it.”
— Andy Hunt [14:23]
Notable Quotes & Memorable Moments
| Time | Speaker | Quote | |----------|--------------|--------------------------------------------------------------------------------------------------------------------------------------------------| | 01:22 | Andy Hunt | “The liver... is really the workhorse of our body and it just doesn’t really get enough love.” | | 04:04 | Andy Hunt | “That’s really important... because it’s really some of our malfunctioning metabolic processes... that are... driving some of the fibrosis...” | | 05:49 | Andy Hunt | “There’s really no easier and cheaper tool than FIB4... the utilization... is still so underutilized...” | | 09:04 | Andy Hunt | “The ELF score specifically is the only FDA indicated serum test being viewed as a prognostic marker for MASLD and MASH...” | | 13:40 | Host | “MAST goes well beyond the liver. The shared pathophysiological mechanisms... contribute to both hepatic fibrogenesis and vascular injury.” | | 14:23 | Andy Hunt | “There’s simple tests like a lipid or ApoB... all diseases have in common: the earlier you catch it, the better you have a chance to do something about it.” | | 16:00 | Andy Hunt | “Here’s to taking better care of our liver.” |
Timestamps for Key Segments
- 00:00–03:08: Introduction; the liver’s central role in metabolic health
- 03:08–05:07: Terminology shift from NAFLD to MASLD and implications
- 05:07–07:33: MASLD progression; the FIB4 as a screening tool
- 07:33–09:04: Clinical action based on FIB4 scores; next steps
- 09:04–11:06: The ELF blood test; rationale, utility, and patient impact
- 11:06–12:08: Proportion of population affected, and secondary testing
- 12:08–13:40: MASLD as a cardiometabolic red flag; importance of upstream assessment
- 13:40–14:23: Pathophysiology and wellness biomarkers for early risk detection
- 14:23–16:00: Making wellness testing accessible and routine; closing remarks
Episode Takeaways
- MASLD diagnosis and prevention require a shift toward early, accessible screening using noninvasive tools like FIB4 and ELF.
- Rethinking liver disease as a manifestation of broader metabolic dysfunction opens doors for deeper risk assessment and prevention of both hepatic and cardiovascular disease.
- Providers—and patients—can leverage existing routine bloodwork to take proactive steps toward better liver and cardiometabolic health.
Summary prepared for listeners and clinicians interested in effective, modern strategies for early liver disease detection and holistic cardiometabolic risk management.