The true clinical value of our study lies in the combination models we developed: i) for borderline MAFLD, the optimal panel combining Tf, ALT, and BMI achieved excellent diagnostic accuracy (AUC 0.840), with balanced sensitivity (84.6%) and specificity (78.3%); ii) for MASH diagnosis, the combination model maintained strong performance (AUC 0.805) with consistent sensitivity (73.5%) and specificity (73.3%). Here, TF is linked to metabolic dysfunction-associated steatohepatitis.