Non-Alcoholic Fatty Liver Disease

Excerpt

This guideline covers identifying, diagnosing and assessing disease severity in adults, children and young people with non-alcoholic fatty liver disease (NAFLD). It also covers both pharmacological and non-pharmacological treatments, disease monitoring and the risk of extra-hepatic conditions associated with NAFLD.

Contents

• Guideline Development Group members
• NGC technical team members
• Co-optees
• Acknowledgements
• 1. Guideline summary
  • 1.1. Algorithm: Assessment and monitoring of NAFLD in adults, children and young people
  • 1.2. Full list of recommendations
  • 1.3. Key research recommendations
• 2. Introduction
  • Background
  • Current practice
  • Need for and scope of the guideline
• 3. Development of the guideline
  • 3.1. What is a NICE clinical guideline?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
• 4. Methods
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Identifying and analysing evidence of effectiveness
  • 4.4. Identifying and analysing evidence of cost-effectiveness
  • 4.5. Developing recommendations
• 5. Risk factors for NAFLD
  • 5.1. Introduction
  • 5.2. Review question: Which risk factors for NAFLD or severe NAFLD (NASH, fibrosis) aid in the identification of people who should be investigated further?
  • 5.3. Clinical evidence
  • 5.4. Economic evidence
  • 5.5. Evidence statements
  • 5.6. Recommendations and link to evidence
• 6. Diagnosis of NAFLD
  • 6.1. Introduction
  • 6.2. Review question: What is (are) the appropriate investigation(s) for diagnosing NAFLD in adults, young people and children?
  • 6.3. Clinical evidence
  • 6.4. Economic evidence
  • 6.5. Evidence statements
  • 6.6. Recommendations and link to evidence
• 7. Diagnosing the severity of NAFLD
  • 7.1. Introduction
  • 7.2. Review question: Which assessment tool is most accurate in identifying the severity or stage of NAFLD?
  • 7.3. Clinical evidence
  • 7.4. Economic evidence
  • 7.5. Evidence statements
  • 7.6. Recommendations and link to evidence
• 8. Monitoring NAFLD progression
  • 8.1. Introduction
  • 8.2. Review question: How often should we monitor adults, young people and children with NAFLD or NASH (with or without fibrosis) to determine the risk of disease progression?
  • 8.3. Clinical evidence
  • 8.4. Economic evidence
  • 8.5. Evidence statements
  • 8.6
  • 8.7. Recommendations and link to evidence
• 9. Extra-hepatic conditions
  • 9.1. Introduction
  • 9.2. Review question: Should a diagnosis of NAFLD in adults, young people and children prompt assessment for additional extra-hepatic conditions and, if so, which?
  • 9.3. Clinical evidence
  • 9.4. Economic evidence
  • 9.5. Evidence statements
  • 9.6. Recommendations and link to evidence
• 10. Weight reduction interventions
  • 10.1. Introduction
  • 10.2. Review question: What is the clinical and cost-effectiveness of dietary interventions for weight reduction for adults, young people and children with NAFLD compared with standard care?
  • 10.3. Clinical evidence
  • 10.4. Economic evidence
  • 10.5. Evidence statements
  • 10.6. Recommendations and link to evidence
• 11. Dietary modification and supplements
  • 11.1. Introduction
  • 11.2. Review question: What is the clinical and cost-effectiveness of dietary modifications or supplements for adults, young people and children with NAFLD compared with standard care?
  • 11.3. Clinical evidence
  • 11.4. Economic evidence
  • 11.5. Evidence statements
  • 11.6. Recommendations and link to evidence
• 12. Exercise interventions
  • 12.1. Introduction
  • 12.2. Review question: What is the clinical and cost-effectiveness of exercise programmes for adults, young people and children with NAFLD compared with standard care?
  • 12.3. Clinical evidence
  • 12.4. Economic evidence
  • 12.5. Evidence statements
  • 12.6. Recommendations and link to evidence
• 13. Lifestyle modification
  • 13.1. Introduction
  • 13.2. Review question: What is the clinical and cost-effectiveness of lifestyle modification programmes for diet and exercise interventions for adults, young people and children with NAFLD compared with diet alone, exercise alone or standard care?
  • 13.3. Clinical evidence
  • 13.4. Economic evidence
  • 13.5. Evidence statements
  • 13.6. Recommendations and link to evidence
• 14. Alcohol advice
  • 14.1. Introduction
  • 14.2. Review question: Should people with NAFLD restrict their consumption of alcohol to below national recommended levels?
  • 14.3. Clinical evidence
  • 14.4. Economic evidence
  • 14.5. Evidence statements
  • 14.6. Recommendations and link to evidence
• 15. Fructose advice
  • 15.1. Introduction
  • 15.2. Review question: Should people with NAFLD restrict their consumption of fructose or sugar?
  • 15.3. Clinical evidence
  • 15.4. Economic evidence
  • 15.5. Evidence statements
  • 15.6. Recommendations and link to evidence
• 16. Caffeine advice
  • 16.1. Introduction
  • 16.2. Review question: Should people with NAFLD modify their consumption of caffeine from coffee?
  • 16.3. Clinical evidence
  • 16.4. Economic evidence
  • 16.5. Evidence statements
  • 16.6. Recommendations and link to evidence
• 17. Pharmacological interventions
  • 17.1. Introduction
  • 17.2. Review question: What is the clinical and cost-effectiveness of pharmacological interventions for adults, young people and children with NAFLD?
  • 17.3. Clinical evidence
  • 17.4. Economic evidence
  • 17.5. Evidence statements
  • 17.6. Recommendations and link to evidence
• 18. Acronyms and abbreviations
• 19. Glossary
• 20. Reference list
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Clinical review protocols
  • Appendix D. Health economic review protocol
  • Appendix E. Clinical article selection
  • Appendix F. Health economic article selection
  • Appendix G. Literature search strategies
  • Appendix H. Clinical evidence tables
  • Appendix I. Health Economic evidence tables
  • Appendix J. GRADE tables
  • Appendix K. Forest plots and diagnostic meta-analysis plots
  • Appendix L. Diagnostic meta-analysis
  • Appendix M. Excluded clinical studies
  • Appendix N. Cost-effectiveness analysis: diagnostic tests for NAFLD and advanced fibrosis
  • Appendix O. Unit costs
  • Appendix P. Review of economic evidence from NICE public health guidance
  • Appendix Q. Research recommendations
  • Appendix R. NICE project team
  • Appendix S. References

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and, where appropriate, their guardian or carer.