As many as two in five Americans have steatotic liver disease, also called SLD or fatty liver disease, yet many won’t know until it reaches an advanced stage. In a pilot study of 14 at-risk, asymptomatic patients last spring, Professor of Medicine Kittichai Promrat, MD, identified three with liver scarring and eight with fatty liver disease using a portable diagnostic imaging tool called FibroScan. But Promrat, a gastroenterologist and hepatologist with Brown University Health and interim director of the Division of Gastroenterology at Brown, says that with a calculation based on routine patient bloodwork, any doctor can catch SLD before it’s too late.

Chronic liver diseases, for the most part, are silent diseases in that they don’t typically cause any symptoms in the earlier stages. Once people start having symptoms, they already have more advanced disease such as cirrhosis. For example, people who drink excessively may not have any symptoms related to their liver in the beginning; they go to their doctor when they have yellowing of the eyes or skin, an abdomen full of fluid, and many other complications of late-stage liver disease.

The other main cause of SLD is metabolic dysfunction, which includes obesity, type 2 diabetes, and dyslipidemia. People with metabolic dysfunction who consume alcohol—even just a drink or two a day—are at particularly high risk of liver complications.

A lot can be done to prevent further progression and, in some cases, reverse the damage, and the interventions are pretty straightforward: alcohol cessation and management of the metabolic issues. Very recently, the FDA approved semaglutide (like Wegovy) and another drug, resmetirom, to treat metabolic-associated steatotic liver disease.

Medical societies recommend screening for SLD among people at high risk, who have metabolic issues, high alcohol use, or elevated liver blood tests. FibroScan is not routinely available in a primary care visit. What any clinician can do right now is an easily accessible calculation called FIB-4, which uses routine blood test values—platelet count, aspartate aminotransferase, and alanine aminotransferase—and the patient’s age. You don’t have to order a separate test; you do a few clicks in the electronic health record and then, based on the level, that should prompt subsequent steps like referral to a liver specialist and second-tier testing like FibroScan.