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Abstract Details
Quality standards for the management of non-alcoholic fatty liver disease (NAFLD): consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD Special Interest Group
1Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. Electronic address: stuart.mcpherson2@nhs.net.
2Liver Unit, Queen Elizabeth University Hospital Birmingham NHS Trust, Birmingham, UK; NIHR Biomedical Research Centre, University of Birmingham, Birmingham, UK.
3Oxford Liver Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; UK NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
4Department of Gastroenterology, Hepatology and Endoscopy, Hull University Teaching Hospitals, Hull, UK.
5Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
6Portsmouth Liver Centre, Queen Alexandra Hospital, Portsmouth, UK.
7Walton Liver Clinic, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.
8Centre for Regenerative Medicine, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK.
9Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Wellcome Trust/MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Cambridge, UK.
10Division of Digestive Diseases, Imperial College, London, UK.
11British Liver Trust, Bournemouth, UK.
12Nottingham University Hospitals NHS Trust, Nottingham, UK.
13Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; The Bellingham Practice, Northumberland, UK.
14Liver Unit, Queen Elizabeth University Hospital Birmingham NHS Trust, Birmingham, UK.
15Barts Liver Centre, Queen Mary University London and Barts Health NHS Trust, London, UK.
16Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Queen Elizabeth Hospital, Gateshead NHS Foundation Trust, Gateshead, UK.
17Digestive Disorders Department, Aberdeen Royal Infirmary, Aberdeen, UK.
18Leeds Liver Unit, St James's University Hospital Leeds, Leeds, UK.
19Leeds Institute for Medical Research, University of Leeds, Leeds, UK.
20North Bristol Liver Unit, Southmead Hospital, North Bristol Trust, Bristol, UK.
21Centre for Liver and Digestive Disorders, The Royal Infirmary, Edinburgh, Edinburgh, UK.
22Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
23UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
24Gwent Liver Unit, The Grange University Health Board, Anuerin Bevan Health Board, Wales, UK.
Abstract
Non-alcoholic fatty liver disease (NAFLD) is common, affecting approximately 25% of the general population. The evidence base for the investigation and management of NAFLD is large and growing, but there is currently little practical guidance to support development of services and delivery of care. To address this, we produced a series of evidence-based quality standard recommendations for the management of NAFLD, with the aim of improving patient care. A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD Special Interest Group produced the recommendations, which cover: management of people with, or at risk of, NAFLD before the gastroenterology or liver clinic; assessment and investigations in secondary care; and management in secondary care. The quality of evidence for each recommendation was evaluated by the Grading of Recommendation Assessment, Development and Evaluation tool. An anonymous modified Delphi voting process was conducted individually by each member of the group to assess the level of agreement with each statement. Statements were included when agreement was 80% or greater. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice. It is hoped that services will review their practice against our recommendations and key performance indicators and institute service development where needed to improve the care of patients with NAFLD.