Intended for healthcare professionals

Practice Guidelines

Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance

BMJ 2016; 354 doi: (Published 07 September 2016) Cite this as: BMJ 2016;354:i4428
  1. Jessica Glen, senior research fellow1,
  2. Lefteris Floros, senior health economist1,
  3. Chris Day, professor of liver medicine and honorary consultant hepatologist2,
  4. Rachel Pryke, general practitioner partner3
  5. on behalf of the Guideline Development Group
  1. 1National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
  3. 3Winyates Health Centre, Redditch B98 0NR, UK
  1. Correspondence to: C Day{at}

What you need to know

  • Screening for non-alcoholic fatty liver disease (NAFLD) in adults is not recommended by the guideline due to lack of evidence

  • Offer children with type 2 diabetes or metabolic syndrome screening for NAFLD using liver ultrasonography

  • Lifestyle modification is the only evidence based management for NAFLD

  • Offer adults with NAFLD screening for advanced liver fibrosis every three years using the enhanced liver fibrosis (ELF) blood test

  • Offer children with NAFLD screening for advanced liver fibrosis every two years using the ELF blood test

There has been a lack of national guidance and care pathways for primary care on when to offer testing for NAFLD. Investigation and referral of suspected NAFLD vary widely. There is currently no licensed treatment for NAFLD, and most people are managed by their general practitioner with a focus on lifestyle advice such as weight loss.

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disease from fatty liver to non-alcoholic steatohepatitis, fibrosis, and cirrhosis. At the least advanced end of the spectrum, non-alcoholic fatty liver (NAFL) is an excess of fat in the liver (steatosis) present in 20-30% of the general population and is largely asymptomatic.1 2 3 4 Currently, diagnosis of NAFLD is most commonly made through incidental findings, such as ultrasonography for investigation of persistently abnormal liver function tests, when other suspected causes have been ruled out.

In around 5-6% of patients with NAFL only the condition progresses to non-alcoholic steatohepatitis (NASH), fibrosis, or cirrhosis (see fig 1).5 In this small group there is a risk of death from liver failure or hepatocellular carcinoma, or needing a liver transplant.1 The number of hospital admissions for liver damage at the more severe end of the NAFLD spectrum, fibrosis and cirrhosis, are increasing every year.6

Fig 1 Spectrum of non-alcoholic fatty …

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