Non-alcoholic fatty liver disease (NAFLD): assessment and management

Context

Primary non-alcoholic fatty liver disease (NAFLD) is an excess of fat in the liver (steatosis) that is not a result of excessive alcohol consumption or other secondary causes. These secondary causes include side effects of certain medications, hepatitis C virus infection and particular endocrine conditions. NAFLD ranges from hepatic steatosis, through inflammatory non-alcoholic steatohepatitis (NASH), to fibrosis or cirrhosis.

The prevalence of NAFLD in the general population is estimated at 20% to 30%. Around 2% to 3% of the population have NASH. NAFLD is more common in people who have type 2 diabetes or metabolic syndrome.

The prevalence of NAFLD is increasing, placing a greater burden on healthcare resources. The rate of progression of NAFLD is variable; being overweight and having diabetes are associated with an increased risk of progressive disease. The average age of people with NASH is 40 years to 50 years and for NASH-cirrhosis 50 years to 60 years. However the emerging epidemic of childhood obesity means that increasing numbers of younger people have NAFLD, with some prevalence studies showing that up to 38% of obese children have evidence of NAFLD. With NAFLD progressing through its spectrum even in childhood, the age that people develop significant liver disease is likely to fall and early diagnosis and management are therefore important at all ages. There is currently no licensed treatment for NAFLD. Guidance is needed for use in both primary and secondary care settings.