We aimed to evaluate FIB-4 performance against elastography, compare it with other non-invasive tests, assess effect modification by BMI, diabetes, sex, ALT, and age, and calibrate 2D shear-wave elastography (2D-SWE) and vibration-controlled transient elastography (VCTE) thresholds.<h4>Methods</h4>We analyzed two cohorts with paired serum scores and elastography: Calgary (2D-SWE; N = 8,126) and Edmonton (VCTE; N = 985). The gene discussed is GPT; the disease is diabetes mellitus.