At-a-glance (high-yield)
- High-risk groups: NAFLD is more common in people with type 2 diabetes or metabolic syndrome.
- Normal LFTs ≠ no NAFLD: routine liver blood tests should not be used to rule out NAFLD or advanced fibrosis.
- Fibrosis matters: NICE recommends testing for advanced fibrosis and using the ELF test where available.
- Key threshold: ELF ≥10.51 suggests advanced fibrosis and warrants specialist referral.
Assessment + testing (NICE NG49 — simplified)
- Identify risk: T2DM, metabolic syndrome, obesity, hypertension, dyslipidaemia.
- Alcohol history: essential to exclude alcohol-related liver disease.
- Imaging: ultrasound can identify fatty liver, but fibrosis risk stratification is still needed for prognosis and referral decisions.
- Do not use: routine LFTs to rule out NAFLD or to assess for advanced fibrosis.
Fibrosis risk + referral thresholds
- Offer fibrosis assessment to people with NAFLD.
- ELF test: consider ELF to test for advanced fibrosis.
- ELF ≥10.51: diagnose advanced fibrosis and refer to hepatology.
- ELF <10.51: advanced fibrosis is unlikely; NICE supports re-assessment every 3 years in adults (2 years in children/young people).
- Statins: people with NAFLD should generally continue statins; only consider stopping if enzymes double within 3 months of starting (align with NG49 and local policy).
- Lifestyle: advise diet and physical activity for NAFLD regardless of BMI; manage metabolic risk in parallel.
Frequently asked questions
Who is NAFLD most common in (who should I prioritise)?
People with type 2 diabetes or metabolic syndrome are high-risk groups; actively consider NAFLD and fibrosis stratification in these patients.
What is the key ELF threshold for “advanced fibrosis”?
NICE NG49 uses an ELF score of 10.51 or above to diagnose advanced fibrosis (in the context of NAFLD), prompting specialist referral.
How often should I re-test if ELF is below 10.51?
NICE NG49 supports re-assessment every 3 years in adults (every 2 years in children/young people) when ELF is below 10.51 and advanced fibrosis is unlikely.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.