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National Guideline Centre (UK). Non-Alcoholic Fatty Liver Disease: Assessment and Management. London: National Institute for Health and Care Excellence (NICE); 2016 Jul. (NICE Guideline, No. 49.)
3.1. What is a NICE clinical guideline?
NICE clinical guidelines are recommendations for the care of individuals in specific clinical conditions or circumstances within the NHS – from prevention and self-care through primary and secondary care to more specialised services. We base our clinical guidelines on the best available research evidence, with the aim of improving the quality of healthcare. We use predetermined and systematic methods to identify and evaluate the evidence relating to specific review questions.
NICE clinical guidelines can:
- provide recommendations for the treatment and care of people by health professionals
- be used to develop standards to assess the clinical practice of individual health professionals
- be used in the education and training of health professionals
- help patients to make informed decisions
- improve communication between patient and health professional.
While guidelines assist the practice of healthcare professionals, they do not replace their knowledge and skills.
We produce our guidelines using the following steps:
- Guideline topic is referred to NICE from the Department of Health.
- Stakeholders register an interest in the guideline and are consulted throughout the development process.
- The scope is prepared by the National Guideline Centre (NGC).
- The NGC establishes a Guideline Development Group.
- A draft guideline is produced after the group assesses the available evidence and makes recommendations.
- There is a consultation on the draft guideline.
- The final guideline is produced.
The NGC and NICE produce a number of versions of this guideline:
- the ‘full guideline’ contains all the recommendations, plus details of the methods used and the underpinning evidence
- the ‘NICE guideline’ lists the recommendations
- ‘information for the public’ is written using suitable language for people without specialist medical knowledge
- NICE Pathways brings together all connected NICE guidance.
This version is the full version. The other versions can be downloaded from NICE at www.nice.org.uk.
3.2. Remit
NICE received the remit for this guideline from the Department of Health. NICE commissioned the NGC to produce the guideline.
The remit for this guideline is:
The management of liver disease (non-alcoholic).
3.3. Who developed this guideline?
A multidisciplinary Guideline Development Group (GDG) comprising health professionals and researchers as well as lay members developed this guideline (see the list of Guideline Development Group members and the acknowledgements).
The National Institute for Health and Care Excellence (NICE) funds the National Guideline Centre (NGC) and thus supported the development of this guideline. The GDG was convened by the NGC and chaired by Professor Chris Day in accordance with guidance from NICE.
The group met every 5 to 6 weeks during the development of the guideline. At the start of the guideline development process all GDG members declared interests including consultancies, fee-paid work, shareholdings, fellowships and support from the healthcare industry. At all subsequent GDG meetings, members declared arising conflicts of interest.
Members were either required to withdraw completely or for part of the discussion if their declared interest made it appropriate. The details of declared interests and the actions taken are shown in Appendix B.
Staff from the NGC provided methodological support and guidance for the development process. The team working on the guideline included a project manager, systematic reviewers (research fellows), health economists and information scientists. They undertook systematic searches of the literature, appraised the evidence, conducted meta-analysis and cost-effectiveness analysis where appropriate and drafted the guideline in collaboration with the GDG.
3.3.1. What this guideline covers
This guideline covers the assessment and management of non-alcoholic fatty liver disease (NAFLD) in adults, children and young people. For further details please refer to the scope in Appendix A and the review questions in Section 4.1.
3.3.2. What this guideline does not cover
This guideline does not cover people with secondary causes of fatty liver (for example, chronic hepatitis C infection, total parenteral nutrition treatment and drug-induced fatty liver), management of end-stage liver disease, hepatocellular carcinoma or liver transplant associated with NAFLD, and the assessment and management of cirrhosis.
3.3.3. Relationships between the guideline and other NICE guidance
Related NICE diagnostics guidance
- SonoVue (sulphur hexafluoride microbubbles) – contrast agent for contrast-enhanced ultrasound imaging of the liver. NICE diagnostics guidance 5 (2012).
Related NICE medical technology guidance
- Virtual Touch Quantification to diagnose and monitor liver fibrosis in chronic viral hepatitis B and C. NICE medical technology guidance MTG27 (2015).
Related NICE clinical guidelines
- Diabetes (type 1 and type 2) in children and young people: diagnosis and management. NICE guideline 18 (2015).
- Suspected cancer: recognition and referral. NICE guideline 12 (2015).
- Obesity: identification, assessment and management of overweight and obesity in children, young people and adults. NICE clinical guideline 189 (2014).
- Chronic kidney disease: early identification and management of chronic kidney disease in adults in primary and secondary care. NICE clinical guideline 182 (2014).
- Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE clinical guideline 181 (2014).
- Atrial fibrillation: the management of atrial fibrillation. NICE clinical guideline 180 (2014).
- Hypertension: clinical management of primary hypertension in adults. NICE clinical guideline 127 (2011).
- Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE clinical guideline 115 (2011).
- Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications. NICE clinical guideline 100 (2010).
- Type 2 diabetes (update). NICE guideline. Publication expected December 2015.
Related NICE public health guidance
- Physical activity: brief advice for adults in primary care. NICE public health guidance 44 (2013).
- Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection. NICE public health guidance 43 (2012).
- Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation. NICE public health guidance 41 (2012).
- Alcohol-use disorders: preventing harmful drinking. NICE public health guidance 24 (2010).
- Promoting physical activity for children and young people. NICE public health guidance 17 (2009).
Related NICE guidance currently in development
- Cirrhosis: assessment and management of cirrhosis. NICE guideline. Publication expected July 2016.
- Development of the guideline - Non-Alcoholic Fatty Liver DiseaseDevelopment of the guideline - Non-Alcoholic Fatty Liver Disease
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