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NAFLD: assessment and management—information for the public

What is NAFLD?

  • NAFLD is a build-up of fat in the liver. About 2 to 3 people in every 10 have this condition. Even young children can have NAFLD. In most people it is not harmful, but sometimes it can get worse, causing the liver to scar (fibrosis). In a small number of people, it can lead to cirrhosis (advanced scarring of the liver). This can cause the liver to stop working completely

  • Having NAFLD can make you more likely to develop diabetes, high blood pressure, or kidney disease. If you already have diabetes, NAFLD means you are more likely to have heart problems

Finding out if you have NAFLD

  • NAFLD is often seen in people who have diabetes or have metabolic syndrome (a combination of linked conditions including high blood pressure and obesity). If a doctor thinks that you might have NAFLD they should ask about your drinking habits to rule out alcohol-related liver disease first. Routine blood tests that look at your general liver health might not pick up NAFLD

  • Most adults find out they have NAFLD when they are being tested for something else

Finding out if children and young people have NAFLD

  • Children and young people who are more likely to have NAFLD should have a liver ultrasound. This includes children and young people with type 2 diabetes or metabolic syndrome. If a scan shows that they don’t have NAFLD they should have another scan every 3 years
  • Children with suspected NAFLD should be seen by a doctor who specialises in liver conditions

What happens if I have NAFLD?

  • Losing weight and exercising more can help people with NAFLD. Many people find that these simple changes can help NAFLD improve or stop it getting worse

  • Alcohol doesn’t cause NAFLD but drinking may make it worse. This means it is important to stay within the government’s alcohol unit guidelines

Can I carry on taking statins if I have NAFLD?

  • If you are taking statins you should carry on taking them unless your doctor tells you to stop. This is because although there is not any evidence that they can treat NAFLD they help with other conditions that people with NAFLD may have such as diabetes. There is also no evidence that people with NAFLD are more likely to have very rare statin-related liver problems than other people

How often should my liver be checked for scarring?

  • NAFLD progresses slowly and it is difficult to tell whose liver disease will get worse. This means you will have to have check-ups to see if your liver is scarring. These will take place every 3 years for adults and every 2 years for children and young people. At each of these check-ups you should be given information about changes that you can make to your lifestyle to prevent your liver from scarring

What happens if my liver starts to scar?

  • Adults and young people with scarring of the liver should be seen by a doctor who specialises in liver conditions. Children with NAFLD should already be under the care of a specialist. People over 16 years with liver scarring should be monitored for cirrhosis – you can read more about this in the cirrhosis information for the public

  • The specialist may be able to start you or your child on treatments that can help. These treatments can only be started by specialist liver doctors. People taking these treatments should be checked after 2 years to make sure the treatments are helping

Making decisions together

  • You should be part of all decisions about your care so you can agree which treatments are likely to suit you or your child best. Your healthcare team should involve you by:

    • talking and listening to you so that they understand what matters to you

    • giving you all the information you need so that you can make your mind up

    • explaining why they think something that is mentioned here won’t work for you, and discussing other options you could try instead

    • giving you details for someone in your care team that you can contact if you have any questions

  • There is more information about how you should be involved in your care on the NICE website

full document available from…

National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT

www.nice.org.uk/guidance/ng49/ifp

National Institute for Health and Care Excellence.

Non-alcoholic fatty liver disease (NAFLD): diagnosis and management—information for the public. July 2016.

First included: December 2017.