MASLD — KFP-style written assessment

KFP 1 (10 marks)

Your practice is designing the type 2 diabetes annual review. A colleague argues liver enzymes are sufficient screening. The practice has 340 patients with T2D. ^{[12] [11]}

1. Quantify the screening need using the pooled prevalence data. (3) ^[12]
2. What does the guideline consensus require for T2D and MASLD screening, and why is it bidirectional? (4) ^[11]
3. What is the recommended first screening step and its rule-out threshold? (3) ^[9]

Model answers

1. Pooled prevalence of MASLD in diabetic adults is 56.9% (95% CI 39.1-74.8) across 81,364 participants in 18 studies; by FibroScan it was 64.3%. Expect roughly half to two-thirds of your 340 T2D patients to have steatotic liver disease. ^[12]
2. Guidelines require assessment of liver fibrosis in all individuals with T2DM and regular dysglycaemia screening in those with MASLD. The relationship is bidirectional: MASLD raises T2DM risk stepwise with fibrosis severity, and T2DM accelerates liver disease progression, worsens insulin resistance and impairs glucose metabolism through shared insulin resistance, inflammation, lipotoxicity, adipose dysfunction and gut-liver axis mechanisms. ^[11]
3. FIB-4 as first-line assessment, with a threshold below 1.3 to rule out advanced fibrosis, followed by VCTE or ELF for secondary stratification. ^[9]