What minimum workflow (repeat-testing interval, escalation thresholds, and referral triggers) do you recommend for implementing NIT-based prognostic stratification for MASLD in primary care/endocrinology so that a high-risk result reliably leads to an actionable care pathway?

Typically, I recommend following what the guidelines say, which is to get a FIB-4 score in the endocrine or primary care clinic in patients who have metabolic risk factors. If the FIB-4 score is less than 1.3, you can proceed with an annual FIB-4 score for monitoring. If it ever increases the 1.3 threshold, then it should warrant additional noninvasive fibrosis assessment or hepatology referral. In patients who are 65 years of age or above, it is recommended to use a cut-off of 2 rather than 1.2. Alternatively, if there is access to transient elastography, this can be used directly in these patients for noninvasive fibrosis assessment, given its increased reliability. In patients with a normal liver stiffness measurement, I base my interval...