Around 30% of adults now have steatotic liver disease, but only a small fraction will progress to cirrhosis. The clinical question is which ones. In part one of this two-part series, Pradeep Mundre speaks with Professor Sven Francque (Antwerp University Hospital), co-author of the 2024 EASL multi-society guidelines on MASLD. They work through the new nomenclature (MASLD, MASH, MetALD), why dysfunctional adiposity rather than BMI is the right lens for risk, and how to use FIB-4 as the gateway test in primary care: below 1.3 to reassure, above 2.67 to refer, gray zone in between. Sven also covers why lean MASLD turns up more often than expected in patients of Asian descent, and the narrow set of scenarios where liver biopsy still earns its place alongside FibroScan and ELF. Part 2 covers treatment and future directions and will be released on the 3rd of June 2026.

MASLD guidelines