Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) also MASLD, formerly NAFLD

Cat 1 · 30 days

appointment within 30 calendar days. MAFLD with concerning features: - Evidence of liver decompensation (e.g. jaundice and/or ascites and/or encephalopathy)

Cat 2 · 90 days

appointment within 90 calendar days. - MAFLD without concerning features and stratified as at high- or unresolved indeterminate-risk of advanced liver fibrosis - Assess MAFLD fibrosis stage: begin with first-line FIB-4 score (FIB-4 calculator) assessment in people aged ≥35 years [https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4] - High risk: FIB-4 score ≥2.7 (or ≥2.0 if over 65 years) - Indeterminate risk: FIB-4 score between 1.3 and 2.7. Proceed with second-line tests (liver elastography or serum fibrosis test). Refer if second-line test results are elevated or if these tests are not available NB: Category 2 cases can be referred to local/regional general physician if gastroenterology access is not locally available

Cat 3 · 365 days

appointment within 365 calendar days. - Patients with MAFLD at low risk of advanced liver fibrosis on first line (FIB-4 <1.3) +/- second-line testing without additional cause of liver disease do not require hepatology referral. - Ongoing primary care management should include: - cardiometabolic risk - liver fibrosis reassessment every 2 years or annual monitoring in patients with type 2 diabetes mellitus