Non-alcoholic fatty liver disease (NAFLD) / metabolic-dysfunction- associated steatotic l...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CHRONIC-NAFLD-MASLD-HCC-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-19 \| pending_clinical_signoff
Diseases	`DIS-HCC`
Sources	`SRC-AASLD-HCC-2023`

Red Flag Origin

Definition	Non-alcoholic fatty liver disease (NAFLD) / metabolic-dysfunction- associated steatotic liver disease (MASLD) with advanced fibrosis (FibroScan ≥10 kPa, FIB-4 ≥2.67, or biopsy METAVIR F3-F4) is a major emerging HCC etiology, now responsible for ~15-20% of HCC cases in Western populations and rising rapidly. Cirrhotic MASLD has annual HCC incidence ~1-2% (similar to HCV/HBV cirrhotic baseline). Non-cirrhotic MASLD with advanced fibrosis can also develop HCC (~0.04-0.2%/year — not high enough for routine surveillance per AASLD but warrants closer follow-up than steatosis alone). Comorbid T2DM, obesity, and metabolic syndrome amplify risk. Modifiable: weight loss (>7% reverses NASH histology in many; >10% can regress fibrosis), glycemic control, GLP-1 agonists (semaglutide), pioglitazone (NASH benefit), resmetirom (newly approved MASH therapy 2024). Prevention- persona RedFlag (§20 v0.4 ch...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "nafld_masld_advanced_fibrosis",
      "value": true
    },
    {
      "finding": "fibroscan_kpa_ge_10",
      "value": true
    },
    {
      "finding": "fib_4_ge_2_67",
      "value": true
    },
    {
      "finding": "biopsy_metavir_f3_f4_nash",
      "value": true
    },
    {
      "finding": "masld_cirrhosis_established",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for MASLD/NAFLD HCC risk. Cirrhotic MASLD meets AASLD HCC-surveillance threshold (US ± AFP q6mo). Non-cirrhotic advanced fibrosis is a gray zone — closer hepatology follow-up but not yet routine surveillance. Major actionable lever: weight loss + cardiometabolic management. STUB pending two-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-CHRONIC-NAFLD-MASLD-HCC-PREVENTION-OBSERVATION - IND-CHRONIC-NAFLD-MASLD-HCC-PREVENTION-OBSERVATION
IND-CHRONIC-NAFLD-MASLD-HCC-PREVENTION-SURVEILLANCE - IND-CHRONIC-NAFLD-MASLD-HCC-PREVENTION-SURVEILLANCE