How is MASLD diagnosed?

MASLD is a common condition where fat builds up in the liver. It is often linked to being overweight and conditions like type 2 diabetes and heart disease.

The information on this page is for:

Adults with MASLD or at risk of MASLD.
Family, friends, carers, and healthcare professionals.

MASLD can also affect children and young people. See our information for parents and families.

There isn’t one simple test that can diagnose MASLD. This can make it difficult for doctors to spot. Many people in the UK with MASLD don’t know they have the condition.

Some people only find out they have MASLD during health checks or tests for another health problem. Sometimes it is diagnosed later, when MASLD has become more advanced. At this stage, people may start to notice symptoms.

On this page:

Tests for MASLD

If your doctor thinks you might have liver disease, they will want to understand the cause and if you have liver damage. To do this, they will use a range of examinations and tests to get a complete picture. This usually includes:

Full medical history

Your doctor will look at your full medical history to rule out other causes of liver disease. They may ask about:

if you drink alcohol and if you have drunk alcohol in the past
other medical conditions you have
medicines you take, including:
- prescription and over-the-counter medicines
- natural, traditional or alternative medicines
- recreational drugs
- vitamins or supplements
what you eat
your smoking history
how active you are
any family history of liver disease

It is important to give your doctor as much information as you can. This will help them diagnose your condition correctly and offer the right care.

Physical examination

This includes measuring your:

height
weight
body mass index (BMI)
waist size
blood pressure

You doctor may also check your body for:

swelling of the liver or spleen
visible veins in the tummy wall
signs of jaundice

Liver blood tests (sometimes called LFTs)

Blood tests help your doctor assess your overall health. They are a good way of seeing if the liver is injured and how well it is working. However, a liver blood test cannot diagnose or rule out MASLD on its own.

Find out more about liver blood tests

Fibrosis scoring systems

Blood tests give your doctor useful clues about your liver health. However, normal results do not always mean you do not have MASLD. That’s why doctors often use scoring systems that combine results from several blood tests. Some scores also consider your age and weight to give a clearer picture of your overall risk.

Common scoring systems include:

Fib-4 (Fibrosis-4 index)

Uses:

a blood test looking at your:
- AST level
- ALT level
- Platelet count
your age

Enhanced Liver Fibrosis (ELF) test

Uses:

a blood test looking at:
- hyaluronic acid (HA)
- a protein called procollagen III amino terminal peptide (PIINP)
- an enzyme called matrix metalloproteinase 1 (TIMP-1)

The scoring system helps your doctor assess your liver health. It can’t measure the exact amount of fat or scarring (fibrosis) in your liver, but it guides your doctor on what to do next based on your level of risk.

Find out more about fibrosis scoring systems

Ultrasound scan

An ultrasound uses sound waves to create a picture of your liver. It shows the shape and surface and helps spot anything unusual. A fatty liver usually looks brighter than a healthy one. Ultrasound scans are usually done in hospital by trained professionals, like sonographers or radiologists. They are very safe and do not hurt.

Find out more about ultrasound scans

Results from initial testing

There are 3 possible results from this initial testing:

1. Low risk

You are unlikely to have advanced liver scarring (fibrosis).
You are unlikely to have later-stage MASLD or cirrhosis.
Your GP will continue to manage your care.
You will need a fibrosis test every 3-5 years to monitor your liver health.

2. Indeterminate risk / further testing needed

It’s unclear if you have advanced liver scarring.
You will need further tests, like more blood tests, scans or a liver biopsy.

3. High risk

You are likely to have advanced liver scarring.
You may have later-stage liver disease and could have cirrhosis.
You will be referred to a specialist liver doctor (hepatologist or gastroenterologist) for further tests and ongoing care.

Further tests

If your results suggest an unclear result or a higher risk, your doctor may refer you for extra tests. These tests check for scarring (fibrosis) in your liver, which is the main sign of how advanced your liver disease is. Tests may include:

Transient elastography (FibroScan)

A FibroScan is a special type of scan used to check your liver. It is quick and painless and uses sound waves to measure how stiff or fatty your liver is.

Find out more about transient elastography and what the results mean

Liver biopsy

Sometimes, blood tests and scans aren’t enough for a clear diagnosis. Your doctor might suggest a liver biopsy. This involves taking a small sample of your liver with a needle. This sample is examined under a microscope in a lab.

Find out more about liver biopsy

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This content was last reviewed: July 2026

Our expert reviewers:

We would like to thank everyone who helped with creating and reviewing this page. Including Dr Jeremy Cobbold, Consultant Hepatologist, Oxford University Hospitals, Professor Stuart McPherson, Consultant Hepatologist, Newcastle upon Tyne Hospitals and Dr Helen Jarvis, GP, Newcastle University. And all our patient reviewers.

Find out how we make our patient information.

Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.