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Recognizing Lean Liver Disease in Clinical Practice Clinicians should consider metabolic liver disease in patients who present with: Normal BMI but central adiposity (increased waist circumference) Mildly elevated liver enzymes without a clear cause Dyslipidemia or insulin resistance features Fatty liver on incidental imaging Routine use of noninvasive tests such as FIB4, ELF score, or transient elastography can help stratify risk and guide hepatology referrals

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