MASH biomarker panel — looking for input

tammy_FL said:

Quarterly for the first year is convention rather than evidence, and it is defensible for a simple reason: it is roughly the interval over which HbA1c…

tammy_FL has the substance of this right. The condition it depends on is worth stating. A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin and B12, and a full blood count. That set catches the things that change, the things that explain symptoms, and the things that alter the prescribing decision. Almost everything else on the long circulating lists is either invariant, uninterpretable without a specific question, or an incidental finding waiting to cause an unnecessary workup.

tammy_FL said:

Quarterly for the first year is convention rather than evidence, and it is defensible for a simple reason: it is roughly the interval over which HbA1c…

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. I would drop the "get everything" instinct further than this thread does. Every extra test is another chance at a false positive, and incidental findings have their own cost in scans, biopsies and worry.

This one has a reasonably settled answer, so here it is. The single most useful discipline is bringing the whole panel to a clinician rather than one flagged value. One out-of-range result in isolation generates anxiety and unnecessary tests; the same result next to the trend and the rest of the panel usually generates a shrug.

Dr.ObesityMed said:

A defensible baseline is short: HbA1c and fasting glucose, a lipid panel with ApoB if you can get it, ALT and AST, creatinine with eGFR, TSH, ferritin…

Agreed, and ALT falling is not the same as fibrosis improving. Enzymes are a crude proxy; FIB-4 or elastography is what tells you about the thing that matters.