classify subjects with or without NAFLD, followed by applying the established cut-off of FIB-4 score on each subgroup to include patients with advanced fibrosis for treatment recommendations (Figure 1). 8 On the other hand, liver stiffness was assessed by transient elastography; a liver stiffness ≥9.6 kPa was classified as advanced fibrosis. Among the 392 subjects with a NAFLD ridge score ≥0.3, 323 had valid liver stiffness measurement (LSM) and 8 (2.5%) had LSM ≥9.6 kPa; 436 out of 530 subjects had valid LSM with a NAFLD ridge score <0.3; 7 (1.6%) had a liver stiffness ≥9.6 kPa. FIB-4 score is useful to screen patients at high risk of advanced fibrosis among suspected NAFLD patients, but probably less satisfactory in this population screening cohort with low prevalence of advanced fibrosis.We suggest further diagnostic testing for fibrosis, namely transient elastography, with or without a serum-based test.