Offer liver ultrasound (fatty liver supports NAFLD) screen for NAFLD in:

• Type 2 diabetes, or metabolic syndrome, and
• Do not misuse alcohol

Testing for advanced liver fibrosis should be offered to those with NAFLD:

• NICE recommends the  ELF testEnhanced liver fibrosis test. Measures specific blood biomarkers: hyaluronic acid (HA), procollagen III amino-terminal peptide (PIIINP), and tissue inhibitor of matrix metalloproteinase 1 (TIMP-1)
• ELF score ≥10.51 is diagnostic of advanced liver fibrosis, in those with NAFLD

No specific management:

• Offer lifestyle modifications (e.g. weight loss, physical activity, stop smoking) and optimise management of comorbidities (e.g. optimise diabetes control, manage concurrent cardiovascular diseases)
• Consider pioglitazone or vitamin E in secondary and tertiary care only

Cirrhosis is a common complication of NAFLD, see this article for monitoring and managing complications.

NICE guideline Non-alcoholic fatty liver disease (NAFLD): assessment and management

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