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For patients at risk of nonalcoholic fatty liver disease, the ELF Score provides an easier way to identify those in need of specialized intervention

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Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder, and affects at least ¼ of the adult population worldwide. It is characterized by the build-up of fat in the liver related to metabolic dysfunction. While the risk of developing NAFLD increases with age, it can affect individuals of any age; in fact, almost 10% of children ages 2 to 19 years have NAFLD.1

An urgent need for diagnosis

As obesity and type 2 diabetes both increase the risk of NAFLD, the growing rate of obesity alone has made the diagnosis and treatment of NAFLD an urgent health concern. Additionally, early metabolic dysfunction, rooted in insulin resistance, is a major driver of NAFLD, along with cardiovascular disease, kidney disease, and other disorders. Encouragingly, NAFLD can be prevented and even reversed with appropriate lifestyle changes when identified early enough.

Most people living with NAFLD are unaware of its presence, so knowledge is critical. Up to 20% of those with NAFLD will develop nonalcoholic steatohepatitis (NASH), characterized by liver inflammation and tissue damage, which can progress to fibrosis, cirrhosis, or liver cancer.2

Based on the typically silent presentation of NAFLD in its early stages, the high rate of development of NASH, and the risk for life-altering consequences, the American Association of Clinical Endocrinology (AACE) and the American Association for the Study of Liver Disease (AASLD) in 2022 released guidelines for the diagnosis of NAFLD and NASH in people at risk, and for monitoring the disease to guide treatment.

Non-invasive blood tests provide critical insights for management

With new therapies becoming available, the importance of identifying patients at risk is more crucial than ever. While there are a few diagnostic tools available, such as liver biopsy and imaging, there is another test which provides a non-invasive way to identify those patients in a high-risk group and most in need of specialized intervention.

According to the guidelines, the recommended initial non-invasive test for an at-risk person is the fibrosis-4 (FIB-4) index, which combines the results of 3 blood tests (platelet count, AST, and ALT) with age. For a patient in a high-risk group with an indeterminate or high score, the enhanced liver fibrosis (ELFTM) Score is recommended.

The ELF Score is the first routine, standardized, direct biomarker blood test for prognostic risk assessment in advanced NASH. The ELF Score requires only a single, non-fasting specimen, and measures 3 direct markers of fibrosis:

  • Hyaluronic acid (HA): Extracellular matrix (ECM) component
  • Procollagen III N-terminal peptide (PIINP): ECM component
  • Tissue inhibitor of metalloproteinase 1 (TIMP-1): Inhibits breakdown of collagen III

Early identification of risk, followed by the appropriate treatment, is the key to reducing the risk for the most serious outcomes from NASH.

You can read more about the ELF Score and find more information about NAFLD and NASH here: Enhanced Liver Fibrosis (ELF™) Score


1. NIDDK. Definition & Facts of NAFLD & NASH

2. Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Disease (AASLD). Clinical Practice Guidelines. 2022;28(5):P528-562. doi:10.1016/j.eprac.2022.03.010

Page Published: October 26, 2023

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