{
  "society": "NICE",
  "version": "ng49_2024",
  "publication_date": "2024-02-01",
  "title": "NICE NG49: Non-alcoholic fatty liver disease (NAFLD): assessment and management (2024 update)",
  "status": "published",
  "recommendations": [
    {
      "recommendation_id": "NICE-2024-R01",
      "topic": "screening",
      "text_en": "Test for advanced liver fibrosis using ELF test in adults with T2DM or metabolic syndrome.",
      "text_kr_summary": "T2DM·대사증후군 성인 ELF 검사.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["27649089"],
      "related_nits": ["ELF"],
      "related_drugs": []
    },
    {
      "recommendation_id": "NICE-2024-R02",
      "topic": "elf_test",
      "text_en": "ELF >= 10.51 indicates advanced fibrosis; refer to specialist.",
      "text_kr_summary": "ELF >= 10.51 진행 섬유화; 전문의 의뢰.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["27649089"],
      "related_nits": ["ELF"],
      "related_drugs": []
    },
    {
      "recommendation_id": "NICE-2024-R03",
      "topic": "fib4_cutoff",
      "text_en": "FIB-4 < 1.3 low risk; > 2.67 high risk; NICE primary care pathway uses FIB-4 first then ELF.",
      "text_kr_summary": "FIB-4 first then ELF 경로.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["17326139"],
      "related_nits": ["FIB-4", "ELF"],
      "related_drugs": []
    },
    {
      "recommendation_id": "NICE-2024-R04",
      "topic": "monitoring",
      "text_en": "Repeat ELF every 3 years in adults with NAFLD without advanced fibrosis.",
      "text_kr_summary": "비진행 NAFLD 3년마다 ELF.",
      "strength": "conditional",
      "evidence_grade": "C",
      "cite_pmids": ["33340572"],
      "related_nits": ["ELF"],
      "related_drugs": []
    },
    {
      "recommendation_id": "NICE-2024-R05",
      "topic": "weight_loss",
      "text_en": "Offer weight management interventions targeting 7-10% weight loss.",
      "text_kr_summary": "체중감소 7-10% 목표.",
      "strength": "strong",
      "evidence_grade": "A",
      "cite_pmids": ["25865049"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "NICE-2024-R06",
      "topic": "vitamin_e",
      "text_en": "Vitamin E may be considered in adults with advanced fibrosis; off-label.",
      "text_kr_summary": "진행 섬유화 비타민 E 고려; off-label.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["20218622"],
      "related_nits": [],
      "related_drugs": ["vitamin_e"]
    },
    {
      "recommendation_id": "NICE-2024-R07",
      "topic": "pioglitazone",
      "text_en": "Pioglitazone may be considered as second-line in advanced fibrosis without contraindications.",
      "text_kr_summary": "진행 섬유화 2차약 피오글리타존.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["27322798"],
      "related_nits": [],
      "related_drugs": ["pioglitazone"]
    },
    {
      "recommendation_id": "NICE-2024-R08",
      "topic": "hcc_screening",
      "text_en": "HCC surveillance in cirrhosis with biannual ultrasound + AFP.",
      "text_kr_summary": "간경변 6개월 초음파+AFP.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["29624699"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "NICE-2024-R09",
      "topic": "alcohol",
      "text_en": "Advise patients with NAFLD to avoid harmful alcohol intake.",
      "text_kr_summary": "유해 음주 회피 권고.",
      "strength": "strong",
      "evidence_grade": "B",
      "cite_pmids": ["28714183"],
      "related_nits": [],
      "related_drugs": []
    },
    {
      "recommendation_id": "NICE-2024-R10",
      "topic": "biopsy",
      "text_en": "Liver biopsy not routinely recommended for diagnosis of NAFLD; reserve for diagnostic uncertainty.",
      "text_kr_summary": "간생검 일상 권고 아님; 진단 불확실 시.",
      "strength": "conditional",
      "evidence_grade": "B",
      "cite_pmids": ["29222917"],
      "related_nits": [],
      "related_drugs": []
    }
  ]
}