How should I manage a patient with newly diagnosed non-alcoholic fatty liver disease (NAFLD) in a primary care setting?

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 ¹.

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 ¹.

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 ¹.

Ensure management of associated conditions such as hypertension, hyperlipidaemia, and type 2 diabetes mellitus, as these increase the risk of disease progression ¹.

Continue statin therapy if prescribed, as people with NAFLD do not have increased hepatotoxicity risk from statins ¹.

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 ¹.

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 ¹.

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 ¹.