Considerations and clinical utility of referral pathways for early detection of liver disease in at-risk populations

Table 2 Summary of guideline recommendations on target population for screening

	Metabolic dysfunction			Elevated ALT	Steatosis
	T2DM	Obesity + ≥ 1 other criteria	≥ 2 criteria
2021 EASL NIT clinical practice guideline	+	+1	+1	+1	-
2021 AGA clinical care pathway	+	+	+	+	+
2023 AASLD practice guidance	+	+1	+1	+2	+
2024 EASL-EASD-EASO clinical practice guideline	+	+	-	+3	+
2025 APASL clinical practice guideline	+	+4	+	+	+

¹Scored yes based on the overarching term “individuals with clinical suspicion of metabolic dysfunction-associated steatotic liver disease such as those with metabolic risk factors” or “at-risk for chronic liver disease (metabolic or alcohol)”.

²Only an indication when it is unexplained.

³Only an indication when it is persistently elevated.

⁴Overweight is also included.

T2DM: Type 2 diabetes mellitus; ALT: Alanine aminotransferase; EASL: European Association for the Study of the Liver; NIT: Non-invasive test; AGA: American Gastroenterological Association; EASD: European Association for the Study of Diabetes; EASO: European Association for the Study of Obesity; APASL: Asian Pacific Association for the Study of Liver; AASLD: American Association for the Study of Liver Diseases.