Initial evaluation of the patient with metabolic dysfunction–associated steatotic liver disease

Metabolic dysfunction–associated steatotic liver disease (MASLD) has emerged as one of the leading causes of chronic liver disease worldwide, with an estimated prevalence of nearly 38% in adult population. This updated nomenclature, replacing NAFLD (Non-Alcoholic Fatty Liver Disease), incorporates metabolic dysfunction criteria and enables more accurate patient stratification. The initial evaluation of patients with suspected MASLD requires a comprehensive approach, including targeted clinical history, focused physical examination, baseline laboratory tests, and imaging modalities to identify steatosis and assess fibrosis. Non-invasive tools such as the FIB-4 index, NAFLD Fibrosis Score, Hepamet Fibrosis Score, and elastography have proven valuable in identifying patients at risk of advanced fibrosis, while liver biopsy remains reserved for selected cases. Ultrasonography, controlled attenuation parameter and magnetic resonance represent useful techniques for detecting and quantifying hepatic steatosis, each with specific advantages and limitations. Integration of these diagnostic methods should be tailored to the clinical context, considering patient age, body mass index, and comorbidities. The future of MASLD evaluation lies in precision medicine, with the adjustment of diagnostic thresholds according to individual characteristics to enhance early detection, prognostic assessment, and management of this highly prevalent disease with growing public health impact.