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Purpose of Review <p>To evaluate how the updated steatotic liver disease (SLD) nomenclature—metabolic dysfunction–associated steatotic liver disease (MASLD), metabolic–alcohol associated liver disease (MetALD), and alcohol-associated liver disease (ALD)—influences the diagnostic performance and clinical applicability of non-invasive tests (NITs) for fibrosis assessment, and to determine the need for phenotype-specific risk-stratification strategies.</p> Recent Findings <p>Across studies published between 2023 and 2025, serum-based NITs such as FIB-4 and NAFLD Fibrosis Score (NFS) retain robust rule-out performance for advanced fibrosis (≥ F3) in MASLD (AUROC ~ 0.75–0.85) and MetALD (AUROC ~ 0.72–0.83), with high negative predictive values (&gt; 95%). In contrast, diagnostic accuracy is consistently lower in ALD (AUROC ~ 0.65–0.75), largely due to alcohol-related transaminase variability and thrombocytopenia. Transient elastography (TE)–based composite scores and emerging machine learning–derived indices (FIB-9, FIB-11, FIB-12) demonstrate higher accuracy in MASLD (AUROC up to ~ 0.90–0.92) with reduced indeterminate zones, although validation in alcohol-predominant phenotypes remains limited.</p> Summary <p>Under the revised SLD framework, non-invasive fibrosis assessment must be phenotype-adapted. A stepwise NIT-based strategy—using FIB-4 for initial risk stratification followed by TE-based or advanced composite algorithms in selected patients—appears most appropriate for MASLD and MetALD, whereas serum-only scores are less reliable in ALD.</p>

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Steatotic Liver Disease: Does Existing Non-Invasive Markers Fit the Updated Nomenclature?

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Ksheetij Tarachand Kothari,
  • Dinesh Jothimani,
  • Mohamed Rela

摘要

Purpose of Review

To evaluate how the updated steatotic liver disease (SLD) nomenclature—metabolic dysfunction–associated steatotic liver disease (MASLD), metabolic–alcohol associated liver disease (MetALD), and alcohol-associated liver disease (ALD)—influences the diagnostic performance and clinical applicability of non-invasive tests (NITs) for fibrosis assessment, and to determine the need for phenotype-specific risk-stratification strategies.

Recent Findings

Across studies published between 2023 and 2025, serum-based NITs such as FIB-4 and NAFLD Fibrosis Score (NFS) retain robust rule-out performance for advanced fibrosis (≥ F3) in MASLD (AUROC ~ 0.75–0.85) and MetALD (AUROC ~ 0.72–0.83), with high negative predictive values (> 95%). In contrast, diagnostic accuracy is consistently lower in ALD (AUROC ~ 0.65–0.75), largely due to alcohol-related transaminase variability and thrombocytopenia. Transient elastography (TE)–based composite scores and emerging machine learning–derived indices (FIB-9, FIB-11, FIB-12) demonstrate higher accuracy in MASLD (AUROC up to ~ 0.90–0.92) with reduced indeterminate zones, although validation in alcohol-predominant phenotypes remains limited.

Summary

Under the revised SLD framework, non-invasive fibrosis assessment must be phenotype-adapted. A stepwise NIT-based strategy—using FIB-4 for initial risk stratification followed by TE-based or advanced composite algorithms in selected patients—appears most appropriate for MASLD and MetALD, whereas serum-only scores are less reliable in ALD.