According to the American Liver Foundation , an estimated 1 in 4 adults live with metabolic-associated steatotic liver disease (MASLD). Concurrently, as global obesity rates rise, so do cases of metabolic dysfunction-associated steatotic hepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH). Often referred to as a "silent killer," MASH can progress without noticeable symptoms, leading to severe liver damage before diagnosis occurs, highlighting the need for early detection. With advancements in noninvasive diagnostic techniques now available for MASH, providers have more effective tools than ever to assess and manage individuals at risk of progressive liver disease, potentially before it causes irreversible harm.
NASH FibroSure® Plus is a complete liver diagnostic that offers a reversible precursor, advanced liver disease, MASLD’s silent disease characteristic, etc.Steatosis, steatohepatitis or liver inflammation, and early liver fibrosis (F1/F2) are reversible. Identification of individuals likely to progress to advanced liver disease is crucial for patient care and broader population health. Given that MASLD is a consequence of metabolic syndrome, guidelines recommend identifying advanced fibrosis in high-risk individuals—those with cardiovascular disease, Type 2 diabetes, and obesity. MASLD is a silent disease that presents with vague or no symptoms. And AST/ALT may not always be elevated in MASLD. Using NASH FibroSure® Plus allows for the right intervention at the right time.
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NASH FibroSure® Plus is the leading noninvasive blood-based diagnostic for MASH, and is the only test to assess and produce a score for each feature of MASH—fibrosis, steatosis and steatohepatitis.
Fibrosis is scarring of the liver. The fibrosis score is most important and actionable. A high value correlates with advanced liver disease (stage F3/F4), prompting intervention to prevent worsening to compensated or decompensated cirrhosis. While individuals with stage F3 fibrosis are at high risk of progression to cirrhosis (stage F4), mild to moderate fibrosis (stage F1/F2) is reversible and affords the opportunity to regress the disease.
Stage | Fibrosis Category | Notes |
|---|---|---|
| F0 | No fibrosis |
|
| F1 | Mild fibrosis | F1 is characterized by only one of the following: Perisinusoidal fibrosis – the accumulation of fibrotic tissue in capillaries and blood vessels between hepatocytes known as the space of Disse Portal fibrosis – fibrotic tissue formed within hepatic arteries, portal veins, and bile ducts, known as portal triads, while periportal fibrosis involves the tissue surrounding portal triads |
| F2 | Moderate fibrosis | Fibrosis is present in both the perisinusoidal AND portal/periportal regions. The overall architecture of the liver remains largely undistorted. |
| F3 | Bridging fibrosis | Portal triads are connected or “bridged” to other portal triads or central veins through fibrous tissue distorting the architecture of the liver, disrupting blood flow and impairing function. |
| F4 | Cirrhosis | Liver architecture is severely disrupted with widespread scarring and deposits of fibrotic tissue and collagen alongside the formation of nodules. The liver is critically impaired. |
What is hepatic steatosis?
Steatosis is lipid or triglyceride accumulation in the liver and is the first indication for MASLD. Steatosis can be asymptomatic or present with vague symptoms. NASH FibroSure® Plus estimates and results steatosis in two categories: mild steatosis, characterized by up to 33% of hepatocytes containing lipids, and moderate to severe steatosis with 34%-100% of hepatocytes containing lipids. The latter category is associated with features of metabolic syndrome, may include inflammation and presents with a higher risk of progressing to steatohepatitis.
What is MASH?
MASH, known as steatohepatitis, is inflammation of the liver due to steatosis. In steatohepatitis, the hepatocytes exhibit ballooning or swelling, and immune cells are found within the lobules, an outcome called lobular inflammation. NASH FibroSure® Plus estimates these features under three categories: mild, moderate and severe, where the degree of ballooning and lobular inflammation affecting hepatocytes becomes increasingly critical. Steatohepatitis can lead to fibrosis.
How does NASH FibroSure® Plus test for the presence of MASLD?
MASLD is graded according to histopathological features. NASH FibroSure® Plus estimates a value for each and correlates it to a stage of each feature based on 10 biomarkers:
By providing scores for fibrosis, steatosis and steatohepatitis, NASH FibroSure® Plus empowers you to create personalized treatment strategies for individuals at risk for progressive MASLD and intervene early.
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