Non-alcoholic fatty liver disease (NAFLD) affects nearly 1 in 3 Americans, is increasing in the Veterans Health Administration, and requires action. It is most common in people living with diabetes (40-70%) or obesity (61-95%), with higher rates in older or Hispanic patients. NAFLD independently increases the risk of diabetes (2-5 fold), heart and kidney disease, cirrhosis, liver cancer, and death. It also impairs health-related quality of life.

NAFLD varies in severity. Of all patients living with NAFLD:

• 65-70% have simple fatty liver (fat accumulation in more than 5% of liver cells).
• 25-30% have nonalcoholic steatohepatitis (NASH) with liver fat, inflammation, and injury, and elevated levels of alanine aminotransferase (ALT) in the blood.
• 4% have NAFLD cirrhosis and/or hepatocellular carcinoma.

NAFLD is the most frequent cause of asymptomatic ALT elevations in primary care patients. The condition usually progresses slowly over decades, with greater progression in people living with diabetes or other liver diseases. NAFLD in combination with advanced fibrosis increases mortality and liver-related events, including transplantation.