MASLD (NAFLD) — ESEGH MCQ
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Correct answer: E — Calculate FIB-4 to assess fibrosis risk and guide need for elastography or referral
The FIB-4 index is the recommended first-line noninvasive tool for initial fibrosis risk stratification in MASLD. Calculated from age, AST, ALT, and platelet count, it is widely accessible and reliably identifies patients at low, indeterminate, or high risk of advanced fibrosis. Elevated FIB-4 or indeterminate results prompt secondary assessment with transient elastography (FibroScan) and specialist referral when features suggest progressive liver disease. Option A is incorrect: biopsy is reserved for establishing definitive MASH diagnosis, assessing inflammatory activity, or resolving discrepancies between noninvasive tests—not for routine initial assessment. Option D (vitamin E universally) is contraindicated in diabetic MASLD patients. Option C (statin discontinuation) is inappropriate; statins are cardiovascular protective and should continue. Option B (pioglitazone universally) is overly broad; thiazolidinediones are reserved for biopsy-proven MASH in select cases.
Reference: Evidence-Based Clinical Practice Guidelines for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) 2026, Japanese Society of Gastroenterology/Japan Society of Hepatology, May 2026. https://pubmed.ncbi.nlm.nih.gov/42118685/