How should I approach the assessment of liver function in a patient wi

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Approach to assessment of liver function in suspected NAFLD:

Do not rely on routine liver blood tests (LFTs) to diagnose NAFLD or to assess for advanced liver fibrosis, as they may be normal even in progressive disease.
Take a detailed alcohol history to exclude alcohol-related liver disease.
Use liver ultrasound to detect hepatic steatosis if NAFLD is suspected, especially in people with type 2 diabetes or metabolic syndrome who do not misuse alcohol.
Assess risk of advanced liver fibrosis using non-invasive tests such as the enhanced liver fibrosis (ELF) test, NAFLD fibrosis score (NFS), or FIB-4 score rather than routine LFTs.
Refer patients with high risk of advanced fibrosis (e.g., ELF score ≥10.51) or clinical signs of advanced liver disease to a hepatology specialist for further assessment, which may include transient elastography (FibroScan) or liver biopsy.
For patients at low risk of advanced fibrosis, manage in primary care with lifestyle advice and reassess fibrosis risk every 3 years using non-invasive tests.
Monitor and manage associated metabolic risk factors (type 2 diabetes, hypertension, dyslipidaemia) and cardiovascular risk as part of holistic care.

This approach ensures accurate assessment of liver disease severity while avoiding over-reliance on LFTs, which can be misleading in NAFLD.

References: ,,

How should I approach the assessment of liver function in a patient with suspected NAFLD?