BariatricNurseD said:

The liver data is among the strongest non-weight findings in the class.

I am going to disagree with the direction of travel here. The thread has converged on the tidiest answer rather than the best-supported one, and those are not the same thing.

Worth separating that from liver and MASH, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

One concrete data point for the thread. With resmetirom now available for MASH, combination approaches are being explored, so the standard of care in this area is moving faster than most threads assume.

Worth separating that from liver and MASH, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

Dr.PeteFamMed said:

I am going to disagree with the direction of travel here.

There is a second half to this that has not been said yet. It is worth asking what the claim would look like if it were false. If nothing would look different, it is not a claim about the world and no amount of discussion will settle it.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

One thing that is still open after LondonLisa’s answer:

Whether normalised enzymes tell you anything about fibrosis, and what the right follow-up measurement is?

Closing the loop on my own question.

Closing the loop. The answer turned out to depend on the detail I had left out of the opening post, which is a lesson about how to ask rather than about the subject.