Clinical update

Non-alcoholic fatty liver disease

Your essential guide to signs, symptoms, treatment and the latest guidelines

Essential facts

Non-alcoholic fatty liver disease (NAFLD) is an excess of fat in the liver that is not the result of excessive alcohol consumption or other secondary causes, such as hepatitis C. According to the National Institute for Health and Care Excellence, fatty liver – steatosis – affects between 20 and 30% of the population and its prevalence is increasing.

Incidence of non-alcoholic fatty liver disease is increasing.  Picture: SPL

What’s new?

In July, NICE published guidance on the assessment and management of NAFLD. This includes recommendations on identifying NAFLD in high-risk groups and children and young people; lifestyle modifications, including physical activity, and diet; and pharmacological treatments, including pioglitazone and vitamin E.


Many of those with mild NAFLD are unlikely to notice any symptoms. Some may experience discomfort in the liver area and tiredness. Most people only find out they have a fatty liver when a routine blood sample – usually liver function tests – shows there may be an issue.

Causes/risk factors

According to the British Liver Trust, generally the likelihood of NAFLD increases with being overweight or obese. It is typically seen in people aged about 50 and is more common in men than women. Other risk factors include: a poor diet; taking little or no exercise; smoking; type 2 diabetes; hypertension; hyperlipidaemia; polycystic ovaries; hepatitis B or C; and taking medications prescribed for other conditions. 

While for many people, steatosis will not advance and a serious condition will not develop, for a minority it can lead to non-alcohol related steatohepatitis, or NASH. This is a more significant condition that may cause scarring of the liver and the development of cirrhosis, causing irreversible damage that may lead to liver failure.

How you can help your patient

Nurses in many different areas of clinical practice can play an integral role in helping to identify those at risk, taking into account their weight, age, general health and lifestyle. If NAFLD is linked to being overweight or obese, nurses can offer advice on how to lose weight gradually and increase physical activity. Nurses can point to evidence showing that gentle weight loss and increasing exercise help to reduce the amount of fat in a patient’s liver.


Expert comment

Lynda Greenslade, clinical nurse specialist in hepatology, Royal Free London NHS Foundation Trust

‘This is particularly useful guidance for nurses working with those at risk of NAFLD, including practice nurses and those who specialise in diabetes. There are not many treatments for NAFLD and the most common is probably weight loss. But even a small decrease in weight can reduce abnormal liver function tests and fat in the liver. Exercise has also been shown to reduce liver fibrosis, while nurses can also give clear advice about reducing alcohol intake.

‘School nurses and health visitors play such an important role in encouraging young people to keep healthy and active, reducing the burden of serious liver and other health issues in later life. As it can take 20 to 30 years to develop cirrhosis, these guidelines are important in raising awareness at a national level, in both primary and secondary care, to reduce the risk of increased premature mortality.’ 

Find out more

NICE, Non-alcoholic fatty liver disease (NAFLD): assessment and management (July 2016)

RCN, Caring for people with liver disease: a competence framework for nursing (September 2015)

British Liver Nurses Forum

British Association for the Study of the Liver (BASL)

British Liver Trust

RCNi articles

Fullward D Alcohol-related liver disease Nursing Standard (March 2014)

Frequent consumption of snacks is worse for the liver than large, regular meals. Clinical digest. Nursing Standard (June 2014)

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