Contents
Nonalcoholic fatty liver disease is a condition in which excess fat accumulates in the liver when the buildup is not primarily explained by heavy alcohol consumption. The condition is now more commonly called metabolic dysfunction-associated steatotic liver disease, or MASLD, because it is closely associated with insulin resistance, excess abdominal fat, abnormal cholesterol or triglycerides, high blood pressure, prediabetes, and type 2 diabetes.
MASLD is often silent. A person may feel well while liver fat, inflammation, or fibrosis—scar tissue—develops gradually. Blood testing cannot independently confirm how much fat or scarring is present in the liver. However, it can reveal liver-cell injury, metabolic risk factors, possible alternative causes of abnormal liver results, and information used in fibrosis-risk calculations.
Ulta Lab Tests provides direct access to many relevant blood tests, including a Nonalcoholic Fatty Liver Disease Base Assessment and a Nonalcoholic Fatty Liver Disease Advanced Assessment. These testing options can help patients gather objective information for more informed conversations with qualified healthcare providers.
Medical disclaimer: Lab testing provides health information but does not replace professional medical evaluation, diagnosis, imaging, or treatment. Results should be reviewed with a qualified healthcare provider.
Nonalcoholic fatty liver disease describes excess fat stored inside liver cells. Under the newer terminology, MASLD is generally identified when liver steatosis is present along with at least one cardiometabolic risk factor and other important causes of liver fat have been considered.
The liver normally processes nutrients, produces proteins, regulates cholesterol, stores energy, and helps remove substances from the bloodstream. When more fatty acids reach or are produced by the liver than it can process or export, fat may begin accumulating within liver cells.
| Previous Term | Current Term | General Meaning |
|---|---|---|
| NAFLD | MASLD | Liver fat associated with metabolic dysfunction |
| Simple fatty liver or NAFL | MASL | Steatosis with little or no evident inflammation |
| NASH | MASH | Steatosis accompanied by liver-cell injury and inflammation |
| NAFLD with fibrosis | MASLD with fibrosis | Fatty liver accompanied by increasing scar tissue |
| NASH cirrhosis | MASH-related cirrhosis | Advanced and extensive liver scarring |
The change from NAFLD to MASLD places greater emphasis on the metabolic factors that commonly contribute to the condition. It also recognizes that metabolic dysfunction and alcohol exposure can overlap. A careful and honest alcohol history remains an important part of evaluating liver disease.
MASLD has become one of the most common forms of chronic liver disease. Its increasing prevalence is closely connected to rising rates of insulin resistance, type 2 diabetes, obesity, metabolic syndrome, and abnormal blood lipids.
The condition matters for two major reasons. First, a proportion of people may progress from simple steatosis to MASH, fibrosis, cirrhosis, liver failure, or liver cancer. Fibrosis stage is one of the most important indicators of future liver-related risk.
Second, MASLD is a metabolic and cardiovascular health signal—not only a liver concern. People with fatty liver frequently have insulin resistance, abnormal lipids, high blood pressure, obesity, or type 2 diabetes. Cardiovascular risk assessment is therefore an important part of a comprehensive fatty liver evaluation.
Risk may increase when a person has one or more of the following:
MASLD can also occur in people whose body mass index is not in the overweight or obesity range. Body composition, visceral fat, ethnicity, genetics, diet, and metabolic health may influence risk independently of body weight.
Most people with early MASLD do not have recognizable symptoms. When symptoms occur, they may be vague and may have many other possible explanations.
| Symptom or Risk Factor | What It May Suggest | Related Tests That May Provide Context |
|---|---|---|
| No symptoms but obesity, diabetes, or high triglycerides | Increased metabolic risk despite feeling well | Comprehensive Metabolic Panel, Hepatic Function Panel, Hemoglobin A1c, Glucose, Lipid Panel, and CBC with Differential and Platelets |
| Persistent fatigue | A nonspecific symptom that may accompany metabolic, blood, thyroid, nutritional, or liver conditions | CBC with Differential and Platelets, Comprehensive Metabolic Panel, Thyroid Panel with TSH, Glucose, Hemoglobin A1c, and Ferritin, Iron and Total Iron Binding Capacity Panel |
| Mild discomfort in the upper-right abdomen | Possible liver enlargement or another abdominal condition | Hepatic Function Panel or Comprehensive Metabolic Panel; clinician-directed imaging may also be needed |
| Elevated ALT or AST | Possible liver-cell injury, although enzyme levels do not identify the cause | ALT Test, AST Test, GGT Test, Hepatitis B Test, Hepatitis C Antibody Test with Reflex to RNA, and Iron Studies |
| Elevated triglycerides or low HDL cholesterol | Possible insulin resistance and increased cardiometabolic risk | Lipid Panel, Hemoglobin A1c, Fasting Glucose, Insulin Test, or Insulin Resistance Panel with Score |
| Type 2 diabetes or prediabetes | Higher likelihood of MASLD and clinically important fibrosis | Hemoglobin A1c, Glucose Test, Comprehensive Metabolic Panel, CBC with Differential and Platelets, and FIB-4 assessment |
| Low platelet count | May occur with advanced fibrosis or portal hypertension but can have many other causes | CBC with Differential and Platelets, Hepatic Function Panel, FIB-4, and clinician-directed fibrosis assessment |
| Jaundice, abdominal swelling, confusion, vomiting blood, or black stools | Possible advanced or acutely serious liver disease | Seek urgent medical assessment rather than relying on self-ordered testing |
Safety note: Yellowing of the skin or eyes, confusion, severe abdominal swelling, vomiting blood, black or tarry stools, fainting, or sudden severe abdominal pain requires prompt medical attention.
Yes. ALT and AST may rise when liver cells are injured, but normal values do not rule out MASLD, MASH, or clinically important fibrosis.
Conversely, elevated liver enzymes do not establish that fatty liver is the cause. Viral hepatitis, alcohol exposure, medications, supplements, autoimmune disease, muscle injury, iron overload, and other conditions can also affect aminotransferase levels.
A complete assessment considers metabolic risk, laboratory trends, medical history, alcohol intake, medications, supplements, imaging, and—when appropriate—noninvasive fibrosis testing.
Blood testing may help patients and healthcare providers answer four practical questions.
An ALT Test, AST Test, Alkaline Phosphatase Test, Bilirubin Total Test, and GGT Test provide different types of information about liver and biliary health.
A Glucose Test, Hemoglobin A1c Test, Insulin Test, Lipid Panel Test, and Apolipoprotein B Test can help identify metabolic patterns associated with MASLD.
Age, AST, ALT, and the platelet count from a CBC with Differential and Platelets can be used to calculate FIB-4. An Albumin Test, Bilirubin Total Test, and Prothrombin Time with INR Test may provide additional context when advanced disease is suspected.
A Hepatitis B Test, Hepatitis C Antibody Test with Reflex to RNA, Ferritin Test, and Iron and Total Iron Binding Capacity Test may help investigate alternative or coexisting causes.
Lab tests cannot directly measure the percentage of liver fat, reliably distinguish simple steatosis from MASH, or stage fibrosis with complete certainty. Imaging and, in selected cases, liver biopsy may still be necessary.
| Test or Biomarker | What It Measures | Why It May Matter | Important Limitation |
|---|---|---|---|
| ALT Test | Alanine aminotransferase, an enzyme found primarily in liver cells | May increase when liver cells are irritated or injured | A normal result does not exclude MASLD, and an elevation is not specific to fatty liver |
| AST Test | Aspartate aminotransferase, an enzyme found in the liver, muscles, heart, and other tissues | Used with ALT and included in the FIB-4 calculation | Muscle injury and other non-liver conditions may raise AST |
| GGT Test | Gamma-glutamyl transferase, an enzyme associated with the liver and bile ducts | May add context to other liver or biliary abnormalities | Alcohol, medications, and several liver conditions may influence the result |
| Alkaline Phosphatase Test | An enzyme produced by the bile ducts, bones, and other tissues | May rise with bile-flow problems or certain liver conditions | An elevated result may originate from bone rather than the liver |
| Bilirubin Total Test | A pigment processed and excreted by the liver | May rise when bilirubin processing or bile flow is impaired | Hemolysis and benign inherited conditions may also affect bilirubin |
| Albumin Test | Albumin, a protein produced primarily by the liver | Low levels may occur when liver protein production is impaired in advanced disease | Nutrition, inflammation, kidney loss, and other conditions can also affect albumin |
| Protein Total and Albumin Test | Total circulating protein and albumin | Provides broader liver, nutritional, and protein-balance information | Abnormal results are not specific to MASLD |
| Prothrombin Time with INR Test | How long blood takes to clot | May reflect reduced production of clotting proteins in advanced liver disease | Anticoagulants, vitamin K status, and other factors can alter the result |
A Comprehensive Metabolic Panel includes several liver-related measurements along with glucose, kidney markers, electrolytes, and proteins. A Hepatic Function Panel provides a more focused review of liver enzymes, bilirubin, albumin, and total protein.
| Test | Why It May Be Relevant |
|---|---|
| Fasting Glucose Test | Measures current blood glucose and may help identify impaired glucose regulation |
| Hemoglobin A1c Test | Estimates average blood glucose exposure during approximately the previous two to three months |
| Insulin Test | Provides information about circulating insulin and glucose regulation |
| C-Peptide Test | Provides information about the body's insulin production |
| Insulin Resistance Panel with Score | Provides a specialized assessment of insulin-resistance patterns when clinically appropriate |
| Lipid Panel Test | Measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides |
| Apolipoprotein B Test | Estimates the number of atherogenic lipoprotein particles and may refine cardiovascular-risk assessment |
| High-Sensitivity C-Reactive Protein Test | Measures a nonspecific marker of systemic inflammation; it does not diagnose liver inflammation |
The Nonalcoholic Fatty Liver Disease Base Assessment combines foundational liver and metabolic biomarkers that may help patients evaluate patterns associated with fatty liver risk.
CBC with Differential and Platelets: Platelets may decrease as advanced liver fibrosis and portal hypertension develop, although a low platelet count can have many unrelated causes.
FIB-4: FIB-4 is calculated from age, AST, ALT, and the platelet count from a CBC with Differential and Platelets. It is widely used as an initial noninvasive tool to estimate the probability of advanced fibrosis.
Commonly used adult interpretation categories include:
Age affects interpretation. FIB-4 is less reliable in adults younger than 35, and a higher lower-risk threshold is often used in adults older than 65. FIB-4 should not be treated as a definitive diagnosis. People with obesity or type 2 diabetes may occasionally have meaningful fibrosis despite a lower score.
When FIB-4 or the overall clinical picture raises concern, a healthcare provider may recommend vibration-controlled transient elastography, the Enhanced Liver Fibrosis test, magnetic resonance elastography, or specialist evaluation.
Depending on the medical history and initial results, additional testing may include:
These tests are not required for everyone. Selection should be based on personal risk factors, symptoms, family history, medical history, and existing results.
A focused baseline may include:
This level may be appropriate for someone with metabolic risk factors, previously elevated liver enzymes, or an incidental imaging report describing hepatic steatosis. The Nonalcoholic Fatty Liver Disease Base Assessment provides a convenient bundled option for foundational testing.
Additional testing may include:
The Nonalcoholic Fatty Liver Disease Advanced Assessment provides a broader evaluation of liver, glucose, insulin-resistance, lipid, and related metabolic biomarkers. Patients should review the current panel contents and preparation instructions before ordering.
A healthcare provider may recommend:
Not everyone needs advanced imaging or a liver biopsy. A staged approach can help reduce unnecessary testing while identifying people who may require closer assessment.
Follow-up monitoring may focus on:
The timing of repeat testing depends on the initial results, metabolic risk, medications, treatment plan, and clinician recommendations.
A reference range represents values found in a laboratory's comparison population. A result outside the range does not automatically mean liver disease, and a result within the range does not guarantee that the liver is free of fat, inflammation, or fibrosis.
A healthcare provider may review:
Laboratory values may be influenced by:
Do not stop or change medications or supplements solely because of an abnormal result. Review possible contributors with the prescribing or treating healthcare professional.
Ulta Lab Tests allows patients to order many blood tests directly online where available. Relevant options include individual liver and metabolic tests, the Nonalcoholic Fatty Liver Disease Base Assessment, and the Nonalcoholic Fatty Liver Disease Advanced Assessment.
Testing is performed through established laboratory networks such as Quest Diagnostics where applicable. Patients can review transparent pricing before ordering, no insurance is required, and eligible HSA or FSA payment may be available where accepted. Results are delivered securely online.
Direct-access testing can make it easier to establish a baseline, monitor previously discussed biomarkers, and prepare for a more productive healthcare visit. It does not replace professional diagnosis, imaging, treatment, or specialist care.
Completing repeat testing under similar conditions can make laboratory trends easier to interpret.
Common tests include an ALT Test, AST Test, Alkaline Phosphatase Test, GGT Test, Bilirubin Total Test, Albumin Test, Glucose Test, Hemoglobin A1c Test, Lipid Panel Test, and CBC with Differential and Platelets. No single blood test independently diagnoses or stages MASLD.
MASLD is the newer name for the condition previously called NAFLD. The updated term emphasizes the relationship between liver fat and cardiometabolic risk factors. NASH, the inflammatory form of the disease, is now called MASH. Older terminology remains common in medical records, research, and patient searches, so both sets of terms may appear.
Blood tests can identify liver abnormalities and metabolic risk factors, but they cannot directly confirm the amount of liver fat. Imaging such as ultrasound, transient elastography, CT, or MRI may identify hepatic steatosis. A liver biopsy is sometimes used when the diagnosis, inflammation, or fibrosis stage remains uncertain, but it is not required for most patients.
Yes. Normal ALT and AST levels do not completely exclude MASLD, MASH, or fibrosis. Results should be considered with diabetes status, body composition, triglycerides, platelet count, imaging, medications, alcohol exposure, and other risk factors.
FIB-4 is a noninvasive fibrosis-risk calculation that uses age, AST, ALT, and the platelet count from a CBC with Differential and Platelets. It helps identify people who may have a lower or higher probability of advanced liver fibrosis. It does not directly measure scar tissue and should not be used as a stand-alone diagnosis.
No. A high result on an ALT Test may indicate liver-cell injury, but it does not identify the cause. Fatty liver is one possibility. Viral hepatitis, alcohol-related injury, medication or supplement effects, autoimmune conditions, and other liver disorders may also raise ALT.
MASLD is closely connected to insulin resistance and cardiometabolic dysfunction. A Hemoglobin A1c Test and Glucose Test evaluate blood-sugar regulation. An Insulin Test may provide additional metabolic context. A Lipid Panel Test evaluates triglycerides, HDL cholesterol, LDL cholesterol, and other cardiovascular-risk markers.
Liver fat and inflammation may improve when the metabolic factors contributing to MASLD are addressed. Weight management, physical activity, glucose control, lipid management, and treatment of related health conditions may be important. The appropriate plan should be individualized with a qualified healthcare professional.
Prescription treatments are available for certain adults with MASH and moderate-to-advanced fibrosis. These treatments are intended for specific patients and require clinical evaluation, prescription, monitoring, and consideration of risks and contraindications. Laboratory testing alone cannot determine whether a medication is appropriate.
Repeat timing depends on the initial results, metabolic risk, fibrosis assessment, medications, and care plan. Some people may need follow-up testing within several months, while lower-risk patients may be monitored less frequently. A healthcare provider can recommend an appropriate interval based on individual circumstances.
Ulta Lab Tests allows consumers to order many relevant liver and metabolic blood tests directly online where available. Options include individual tests, the Nonalcoholic Fatty Liver Disease Base Assessment, and the Nonalcoholic Fatty Liver Disease Advanced Assessment. Direct ordering provides information for discussion with a healthcare professional but does not replace diagnosis, imaging, treatment, or specialist evaluation.
Nonalcoholic fatty liver disease—now commonly called metabolic dysfunction-associated steatotic liver disease—is a growing health concern because it is common, often silent, and closely connected to diabetes, insulin resistance, abnormal lipids, cardiovascular disease, and obesity.
Blood tests cannot diagnose every stage of MASLD on their own, but they can reveal liver injury, metabolic risk, possible alternative causes, and information used to estimate fibrosis risk. Reviewing ALT, AST, GGT, bilirubin, albumin, platelets, glucose, Hemoglobin A1c, insulin, and lipids together creates a more useful picture than focusing on a single result.
Ulta Lab Tests provides convenient access to individual liver and metabolic tests as well as the Nonalcoholic Fatty Liver Disease Base Assessment and Nonalcoholic Fatty Liver Disease Advanced Assessment. Explore the available testing options and review your results with a qualified healthcare provider who can determine whether additional evaluation, imaging, monitoring, or treatment is appropriate.
FIB-4 note: FIB-4 is a calculated fibrosis-risk score based on age, AST, ALT, and platelet count. It is not a separate blood test product.
These tests may be considered selectively based on medical history, symptoms, initial laboratory findings, and healthcare-provider guidance.
Ulta Lab Tests, LLC.
9237 E Via de Ventura, Suite 220
Scottsdale, AZ 85258
480-681-4081
(Toll Free: 800-714-0424)
