Diagnosis of nonalcoholic fatty liver disease (NAFLD).

Nonalcoholic fatty liver disease (NAFLD) increases mortality from liver and heart disease and is the most important cause of hepatocellular carcinoma (HCC), which is rapidly becoming more common. Those having an increased fibrosis risk, cirrhosis or HCC should be identified amongst those with simple steatosis. Liver enzymes should always be determined at the yearly follow-up of patients with type 2 diabetes and those with the metabolic syndrome. Fatty liver should lead to an assessment of the risk of fibrosis by using a simple fibrosis test and to the referral of patients at risk by a specialist for diagnosis and treatment of NASH and fibrosis. NASH can only be diagnosed using a liver biopsy.