Box 1.

Common questions

Q: I have an USS report with an incidental finding of fatty liver — do I code the patient as having NAFLD? A: Not yet — just as not all coronary plaque is considered IHD, not all fatty liver on USS is NAFLD. If there are associated deranged LFTs or raised fibrosis markers then NAFLD can be diagnosed (in the absence of other pathology). NB: though not strictly NAFLD, individual CCGs may wish this coded as such for funding reasons. Q: My patient has a fatty liver and a mildly raised ALT (<4 × ULN). Their FIB-4 score is 0.9. Do I need to refer? A: This patient likely has NAFLD but a low risk of progression. You should discuss lifestyle modifications and aim to optimise comorbid metabolic risk factors. Re-assess FIB-4 in 2–3 years. Q: My patient has mildly deranged LFTs (<4 × ULN) and evidence of fibrosis on Fibroscan. Can I continue their statin? A: Yes. Statins are safe and will reduce cardiovascular risk.

ALT = alanine aminotransferase. CCG = clinical commissioning group. IHD = ischaemic heart disease. LFTs = liver function tests. NAFLD = non-alcoholic fatty liver disease. ULN = upper limit of normal. USS = ultrasound scan.