The 2025 Australian Guideline Every GLP-1 Patient Should Know About — MAFLD Screening Explained

This wasn't a single opinion or a manufacturer-sponsored recommendation. The consensus statement was developed by a multidisciplinary panel of leading Australian hepatologists, general practitioners, endocrinologists, and chemical pathologists, including Leon A. Adams, William W. Kemp, Kate R. Muller, Elizabeth E. Powell, Stuart K. Roberts, Luis Calzadilla Bertot, Stephanie Best, Gary Deed, Jon D. Emery, Samantha L. Hocking, Graham R. Jones, John S. Lubel, Sinead Sheils, Stephen M. Twigg, and Gerald F. Watts.

That breadth of authorship matters: this guideline reflects agreement across the specialists who actually diagnose and treat liver disease (hepatologists), the doctors most Australians see first (GPs), the specialists managing the metabolic conditions most closely linked to fatty liver disease (endocrinologists), and the pathologists responsible for the blood tests underpinning the whole pathway.

One of the most important and least widely known points the guideline makes is that standard liver enzyme tests are neither sensitive nor specific for MAFLD — meaning the condition can be present even when a person's routine liver function blood test results come back completely normal. This is precisely why a dedicated screening pathway is needed, rather than relying on standard pathology results to flag a problem.

The guideline establishes a clear, two-step, sequential pathway rather than jumping straight to an imaging scan for everyone:

Step 1 — FIB-4 score. This is a calculation based on age, AST and ALT (standard liver enzymes), and platelet count — values that can typically be derived from blood tests many patients have already had, or that can be ordered specifically for this purpose. It's a simple, low-cost, non-invasive starting point.

Step 2 — Liver elastography, if the FIB-4 result is indeterminate or high-risk. Rather than every single screened patient needing a scan, the FIB-4 score stratifies people into risk categories, with elastography (such as FibroScan) reserved for those whose FIB-4 result indicates further assessment is warranted. This keeps the pathway efficient — most low-risk patients won't need a scan at all, while patients whose blood-based risk score suggests a genuine concern get directed to the more detailed assessment.

This sequential, blood-test-first approach is exactly why the guideline matters for accessibility: it doesn't require everyone with a risk factor to immediately get an expensive or less accessible scan. It identifies, cheaply and simply, who actually needs that next step.

FIB-4 calculator →

GLP-1 liver monitoring guide →

1. Ask whether a FIB-4 assessment is appropriate for you, given your reason for being on GLP-1 therapy. If you have obesity, type 2 diabetes, or other metabolic risk factors, the guideline suggests you should be screened.
2. Don't assume normal liver function tests mean you don't need this. As above, standard liver enzymes aren't a reliable screening tool on their own for this specific condition.
3. If your FIB-4 result comes back indeterminate or elevated, ask about next steps — the guideline's pathway leads to liver elastography (such as FibroScan) at this point, not straight to a more invasive procedure.
4. Raise this proactively if your prescriber hasn't mentioned it — particularly if your GLP-1 prescription came through a streamlined or telehealth-based pathway that may not have included this assessment as standard.

Complete GLP-1 monitoring guide →