Improved diagnostic strategies and care models enhance fibrosis detection and risk stratification in steatotic liver disease
Background
Steatotic liver disease (SLD), encompassing MASLD and MetALD, is a rapidly growing global health concern, often progressing silently to advanced fibrosis and cirrhosis. Clinical outcomes are primarily determined by fibrosis stage, which represents the strongest predictor of liver-related and all-cause mortality. Current diagnostic approaches, especially in primary care, frequently fail to identify individuals until late stages, leading to significant underdiagnosis and delayed intervention. This consensus addresses the critical need for improved strategies to detect and risk-stratify SLD patients early, optimizing resource utilization and accelerating access to care.
Study Design
This consensus paper synthesized an updated systematic literature review (January-November 2025) on steatotic liver disease (SLD) diagnostics. A structured Delphi process was conducted, involving iterative anonymous voting among 40 international experts representing hepatology and related fields. The aim was to redefine nomenclature, assess current diagnostic gaps, and propose improved models of care for fibrosis detection and risk stratification in SLD, building upon initial consensus recommendations.
Results
The consensus identified that steatotic liver disease (SLD) remains widely underdiagnosed, with non-invasive tests (NITs) for fibrosis assessment inconsistently applied in primary care settings. This leads to many individuals being unidentified until advanced cirrhosis or severe complications develop. The experts emphasized the dynamic nature of SLD, requiring regular re-evaluation to maintain accurate classification and guide prevention, treatment, and care.
Risk-stratified, sequential diagnostic strategies, including timely access to guideline-recommended second-line tests, were strongly endorsed to improve detection of significant and advanced fibrosis. These optimized strategies are crucial for reducing misclassification, enhancing resource utilization, and accelerating linkage to appropriate care.
Key Findings
- Steatotic liver disease (SLD) is widely underdiagnosed due to inconsistent application of non-invasive fibrosis tests.
- Risk-stratified, sequential diagnostic strategies improve detection of significant/advanced fibrosis.
- These strategies reduce misclassification and optimize resource utilization in SLD management.
- Timely access to guideline-recommended second-line tests is crucial for accelerating linkage to care.
- Regular re-evaluation of SLD classification is required due to its dynamic nature and fluctuating risk factors.
Why It Matters
This consensus provides a critical roadmap for improving early detection and management of steatotic liver disease (SLD). For clinicians, it underscores the urgent need to integrate non-invasive fibrosis assessment into routine primary care, moving beyond late-stage diagnosis. The emphasis on risk-stratified, sequential diagnostic pathways means patients can be identified earlier, potentially preventing progression to cirrhosis and reducing mortality. This shift could lead to more timely interventions and better resource allocation in healthcare systems. For individuals, it highlights the importance of proactive screening and follow-up, especially for those with cardiometabolic risk factors, enabling earlier access to lifestyle modifications or emerging pharmacotherapies for SLD.
steatotic liver disease
masld
nafld
fibrosis
liver disease
diagnostics