Manage a patient with newly diagnosed NAFLD in primary care by first excluding other causes of liver disease and assessing the risk of advanced liver fibrosis using non-invasive tests such as the NAFLD fibrosis score (NFS), FIB-4, or ELF NICE CKS.
Offer lifestyle modification advice on diet, physical activity, and regular exercise to all patients with NAFLD, encouraging gradual, sustained weight loss of 5-10% over 6 months with a target calorie deficit of 600 kcal/day; a Mediterranean diet and water intake are recommended NICE CKS.
Advise on alcohol intake within national recommended limits, noting that moderate alcohol consumption might be protective, but drinking alcohol in obesity increases liver disease risk NICE CKS.
Ensure management of associated conditions such as hypertension, hyperlipidaemia, and type 2 diabetes mellitus, as these increase the risk of disease progression NICE CKS.
Continue statin therapy if prescribed, as people with NAFLD do not have increased hepatotoxicity risk from statins NICE CKS.
In cases where there is suspicion of advanced fibrosis or signs of advanced liver disease, refer to a hepatology specialist for further assessment, which may include transient elastography or liver biopsy NICE CKS.
Reassess annually in primary care for those with low risk of advanced fibrosis, and consider retesting for advanced fibrosis every 3 years if ELF score is below 10.51 NICE CKS.
Provide patients with information and support resources, such as the British Liver Trust, and discuss the absence of licensed drug treatments, emphasizing lifestyle changes as the main management strategy NICE CKS.