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Contemporary non\u2011invasive risk stratification uses simple serum scores (e.g., Fibrosis\u20114 index [FIB\u20114]) as a first step, followed by vibration\u2011controlled transient elastography (VCTE) or liver\u2011specific blood tests (enhanced liver fibrosis [ELF], procollagen III N\u2011terminal propeptide [PRO\u2011C3]) to refine risk and triage referrals. Magnetic resonance elastography (MRE) provides higher accuracy than ultrasound\u2011based elastography, though limited by its availability. Composite models (Agile 3+\/4, steatosis\u2011associated fibrosis estimator [SAFE]) can reduce indeterminate classifications but may require additional calibration for alcohol exposure for use in MetALD. Prognosis should incorporate dynamic, longitudinal measurement of non\u2011invasive tests, and integrate extrahepatic risks, particularly cardiovascular and kidney disease. In MetALD, quantitative alcohol assessment can be improved by incorporating objective biomarkers such as phosphatidylethanol (PEth) as part of a triangulation approach that integrates self\u2011reported alcohol intake, the Alcohol Use Disorders Identification Test\u2011Consumption (AUDIT\u2011C), and clinical history. Challenges remain, particularly for MetALD, and future research will focus on integrating dynamic biomarkers, predicting treatment response, and utilizing artificial intelligence (AI) for personalized risk and treatment prediction, combining genetic modifiers and polygenic risk scores with clinical and imaging data, with validation across diverse populations.<\/jats:p>","DOI":"10.3350\/cmh.2026.0398","type":"journal-article","created":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T23:28:36Z","timestamp":1788132516000},"page":"e2026.0398","update-policy":"https:\/\/doi.org\/10.3350\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk assessment in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-related liver disease: current approaches and future directions"],"prefix":"10.3350","volume":"32","author":[{"given":"Huapeng","family":"Lin","sequence":"first","affiliation":[{"name":"State Key Laboratory of Organ 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