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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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Therefore, because of this void in data and information, recommendations regarding the use of methylene blue concomitantly with medications and supplements that affect serotonin or MAOI should be done conservatively and on an individualized basis