title: Presence and severity of non-alcoholic fatty liver disease in a large prospective primary care cohort.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) is a common cause of abnormal LFTs in primary care, but there are no data defining its contribution nor reporting the range of NAFLD severity in this setting. This study seeks to calculate the range of disease severity of NAFLD in a primary care setting.
  
  
  METHODS
  Adult patients with incidental abnormal LFTs, in the absence of a previous history, or current symptoms/signs of liver disease were prospectively recruited from eight primary care practices in Birmingham. NAFLD was diagnosed as fatty liver on ultrasound, negative serological liver aetiology screen, and alcohol consumption ≤30 and ≤20 g/day in males and females, respectively. The NAFLD Fibrosis Score (NFS) was calculated to determine the presence or absence of advanced liver fibrosis in subjects identified with NAFLD.
  
  
  RESULTS
  Data from 1118 adult patients were analysed. The cause of abnormal LFTs was identified in 55% (614/1118) of subjects, with NAFLD (26.4%; 295/1118) and alcohol excess (25.3%; 282/1118) accounting for the majority. A high NFS (>0.676) suggesting the presence of advanced liver fibrosis was found in 7.6% of NAFLD subjects, whereas 57.2% of NAFLD patients had a low NFS (<-1.455) allowing advanced fibrosis to be confidently excluded.
  
  
  CONCLUSIONS
  NAFLD is the commonest cause of incidental LFT abnormalities in primary care (26.4%), of whom 7.6% have advanced fibrosis as calculated by the NFS. This study is the first of its kind to highlight the burden of NAFLD in primary care and provide data on disease severity in this setting.
authors.affiliation: Centre for Liver Research, NIHR Liver Biomedical Research Unit, University of Birmingham, UK. mattyarm@doctors.org.uk
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Diarmaid D
authors.initials: DD
authors.lastname: Houlihan
authors.forename: Louise
authors.initials: L
authors.lastname: Bentham
authors.forename: Jean C
authors.initials: JC
authors.lastname: Shaw
authors.forename: Robert
authors.initials: R
authors.lastname: Cramb
authors.forename: Simon
authors.initials: S
authors.lastname: Olliff
authors.forename: Paramjit S
authors.initials: PS
authors.lastname: Gill
authors.forename: James M
authors.initials: JM
authors.lastname: Neuberger
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Lilford
authors.forename: Philip N
authors.initials: PN
authors.lastname: Newsome
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005234:Fatty Liver / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D011320:Primary Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index