Intended for healthcare professionals

Clinical Review

Non-alcoholic fatty liver disease

BMJ 2014; 349 doi: (Published 29 July 2014) Cite this as: BMJ 2014;349:g4596
  1. Naveed Sattar, professor1,
  2. Ewan Forrest, consultant2,
  3. David Preiss, clinical senior lecturer1
  1. 1BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK
  2. 2Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
  1. Correspondence to: N Sattar naveed.sattar{at}

Summary points

  • Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver disease with key stages consisting of hepatic steatosis (NAFL), steatohepatitis (NASH), fibrosis, and eventual cirrhosis

  • NAFLD affects more than 20% of populations worldwide and most patients with type 2 diabetes mellitus

  • The risk of progressive liver disease in the earliest stage of NAFLD, hepatic steatosis, is low but patients with NASH are at far higher risk, and hepatic steatosis due to NAFLD is also a major risk factor for the development of type 2 diabetes

  • Most patients with NAFLD are asymptomatic and the disease is typically suspected based on raised alanine aminotransferase (ALT) levels together with other clinical and biochemical features, or an incidental finding during abdominal ultrasonography

  • Owing to the slow progression of NAFLD, randomised clinical trials have been unable to identify drugs that conclusively reduce progression to cirrhosis, but sustained weight loss has been shown to improve liver function test results and liver histology and thus lifestyle improvement remains the key intervention

  • There is no convincing evidence that NAFLD independently increases a patient’s cardiovascular risk but there is also no reason to withhold statins in patients with NAFLD who are at high cardiovascular risk unless transaminase levels are more than three times the upper limit of normal

Non-alcoholic fatty liver disease (NAFLD) is now more common than alcoholic liver disease owing to the rapid rise in the prevalence of obesity,1 and NAFLD is the most common cause of abnormal liver function tests.2 Its prevalence worldwide is thought to be approximately 20% in the general population and up to 70% in patients with type 2 diabetes mellitus.3 The first recognisable stage of NAFLD is hepatic steatosis, when fat content exceeds 5% of liver volume. Simple steatosis is usually benign in terms of risk of progression to …

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