Fatty Liver Blood Test Panel (MASLD, formerly NAFLD): Liver Enzymes, FIB-4 Inputs & Metabolic Markers

Six tests from one fasting blood draw: the Comprehensive Metabolic Panel (ALT, AST, alkaline phosphatase, bilirubin, albumin, total protein, fasting glucose, kidney function and electrolytes), GGT (gamma-glutamyl transferase, a liver and bile-duct enzyme that also rises with alcohol), a CBC with differential (including the platelet count used in FIB-4), a standard lipid panel (total cholesterol, LDL, HDL, triglycerides, non-HDL), hemoglobin A1c (average blood sugar over about three months) and fasting insulin.

Adults with overweight or obesity, prediabetes or type 2 diabetes, high triglycerides or low HDL, or high blood pressure, since these are the risk factors that define MASLD; people told on an ultrasound or CT that they have a fatty liver who want their liver enzymes and FIB-4 inputs checked; people with a previous high ALT or AST that was never followed up; and anyone a clinician has asked to repeat liver and metabolic labs to track changes over time.

Further reading: Hepatic Function Panel: ALT vs AST Liver Enzyme Ratio; GGT The Most Sensitive Liver Enzyme: What You Need to Know.

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When you have one or more metabolic risk factors and have not had liver enzymes and a platelet count checked recently, after an imaging report mentions fatty liver or steatosis, or when a clinician wants to repeat FIB-4 inputs to follow changes over time. Book a morning appointment after a 10- to 12-hour fast. Recent illness can temporarily change liver test results, so if you have just been sick, consider waiting until you have recovered.

Results are read together. A high ALT or AST shows the liver is under stress but does not say why: fatty liver is a common cause, and alcohol, medicines, viral hepatitis and other conditions are others. A high GGT with a high alkaline phosphatase points to the liver or bile ducts rather than bone. A low platelet count is worth reviewing with a clinician, since it is part of the FIB-4 score. An A1c of 5.7% or higher, triglycerides of 150 mg/dL or higher, low HDL or a high fasting insulin with normal glucose describe the metabolic pattern behind MASLD. Your clinician can use your age, AST, ALT and platelets to calculate FIB-4: under AASLD guidance a low score means advanced fibrosis is unlikely, and a higher score usually leads to elastography (such as FibroScan) or another noninvasive test. Normal results do not rule out fatty liver, which is seen on imaging. JustLabs results are informational: review them with a clinician, who may order an ultrasound, elastography or tests for other causes such as hepatitis B and C.