Non-alcoholic fatty liver disease: leading the fight in primary care

IN PRIMARY CARE GPs are no strangers to non-alcoholic fatty liver disease (NAFLD) and are commonly faced with non-specific liver function tests (LFTs) or an incidental finding of steatosis on ultrasound scan (USS). Interpreting these results and conveying their significance to the patient can be a challenge, with huge variation in practice. NAFLD is a spectrum of liver abnormalities from simple fat deposition (steatosis) to inflammation (non-alcoholic steatohepatitis, NASH). Steatohepatitis causes persistent hepatocellular inflammation leading to fibrosis that can, in some individuals, progress to cirrhosis. The disease burden of NAFLD is rising, now the most common liver disease globally, affecting up to 46% of all adults.1 Importantly, only 0.5% of patients are expected to progress to cirrhosis, which carries a risk of liver failure.2 Patients with NAFLD are at greater risk of all-cause mortality and, for most patients, the risk of non-hepatic ill health greatly outweighs the risk of liver-related morbidity.1–3 NAFLD is overwhelmingly associated with modifiable lifestyle factors, with obesity and metabolic syndrome the key drivers.1 This review describes how and when to make a diagnosis of NAFLD, the use of fibrosis markers to identify patients at risk of significant disease, and appropriate follow-up.