Non Alcoholic Fatty Liver Disease
NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Cornwall NAFLD patient leaflet available here
- USS shows fatty liver disease with: AST/ALT >0.8* AND/OR negative liver screen
- Check BP, BMI, check for signs of advanced liver disease clinically.
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Calculate NAFLD score to assess risk of significant fibrosis:
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NAFLD score link
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Intermediate/High fibrosis risk (NAFLD > -1.455) - refer direct access fibroscan (via RMS)
- (See flowchart)
- <10KpA –lifestyle advice (see low fibrosis risk). Consider rereferral for fibroscan after 3 years only if significant weight gain/increase in alcohol etc (as risk <1% for those with <10KpA)
- 10-11.9kPa – Repeat fibroscan in 1 year (Hepatology will arrange recall)
- >12kPa – Hepatology outpatient assessment
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Low fibrosis risk (NAFLD <-1.455):
- Weight loss - recommended target weight loss of 10% over 6 months (rapid weight loss should be avoided due to the risk of worsening liver inflammation and fibrosis).
- Alcohol advice
- Treat diabetes
- Annually review cardiovascular risk6 (depending on clinical judgement) -BP, QRISK and consider statin(2/3 of mortality in NAFLD is cardiovascular)
- Every 3 years6- Re-assess for signs of advanced liver disease and fibrosis risk (FBC, LFTs, HbA1c, BMI) every 3 years. If worse re-calculate NAFLD score for those who have not had a fibroscan ever and refer if necessary. Those who have had a fibroscan already (with <10 KpA) only re-refer after 3 years if significant deterioration (e.g. significant increase in weight/alcohol/diabetes/LFTs).
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Intermediate/High fibrosis risk (NAFLD > -1.455) - refer direct access fibroscan (via RMS)
-
NAFLD score link
*AST: ALT < 0.8 is sensitive for exclusion of significant disease but > 0.8 not very specific for disease and thus may result in unrequired further investigation.
REFERENCES:
- Guidelines on the management of abnormal liver blood tests. Newsome PN, et al. Gut 2017;0:1–14. doi:10.1136/gutjnl-2017-314924
- Lilford RJ, Bentham L, Girling A, et al. Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study. Health Technol Assess 2013;17:1–307
- Angulo P, Hui JM, Marchesini G et al. The NAFLD fibrosis score A noninvasive system that identifies liver fibrosis in patients with NAFLD Hepatology 2007;45(4):846-854 doi:10.1002/hep.21496
- Sterling RK, Lissen E, Clumeck N, et. al. Development of a simple noninvasive index to predict significant fibrosis patients with HIV/HCV co-infection. Hepatology 2006;43:1317-1325.
- McPherson S, Stewart SF, Henderson E et al. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut 2010;59:1265–9 doi:10.1136/gut.2010.216077
- CKS. Non-Alcoholic Fatty Liver Disease. Viewed 11 October 2021. https://cks.nice.org.uk/topics/non-alcoholic-fatty-liver-disease-nafld/management/management/#follow-up
Review Date 13/03/2022
Next Review Date 13/03/2023
GP Lead Sifter Dr Madeleine Attridge Gastroenterology Lead RMS
Contributor Dr Hyder Hussaini Consultant Gastroenterologist RCHT