Diabetes and obesity reduce FIB-4 accuracy in MASLD referral pathways

Recent guidelines recommend clinical care pathways for risk stratification of patients with MASLD (metabolic dysfunction-associated steatotic liver disease) using sensitive serum-based markers (<i>e.g</i>. fibrosis 4 index [FIB-4]) as a first step, with a cut-off of <1.30 to rule out advanced fibrosis. In patients with diabetes or obesity, the interpretation of a FIB-4 threshold of <1.30 is different than in patients without these conditions. This finding suggests the need to refine referral pathways in which FIB-4 is used as a first test. New referral models incorporating patient characteristics could improve risk stratification of patients with MASLD who need specialized liver care.