DOI: https://doi.org/10.36347/sasjm.2025.v11i12.006

Pages: 1169-1173

Non-alcoholic fatty liver disease (NAFLD) represents one of the most common chronic liver disorders globally and has become increasingly recognised as a multisystem condition strongly associated with obesity, insulin resistance, type 2 diabetes and cardiovascular disease. Abdominal ultrasound remains the most widely used imaging modality for identifying hepatic steatosis, with many cases detected incidentally during investigations for unrelated complaints. Although these findings provide a potential opportunity for early identification of metabolic risk, incidental NAFLD is frequently overlooked or labelled as clinically insignificant. Evidence suggests that limited awareness, incomplete metabolic assessment and lack of structured counselling are common following incidental detection. This omission has important implications because NAFLD can progress to non-alcoholic steatohepatitis, fibrosis, cirrhosis and hepatocellular carcinoma, and is associated with increased cardiovascular morbidity and mortality. Early intervention focusing on weight reduction, dietary modification and physical activity can improve hepatic fat, slow progression and reduce cardiometabolic risk. However, adoption of evidence-based management strategies remains inconsistent, particularly in primary care where NAFLD is often first recognised. These challenges are amplified in settings with high metabolic risk such as Saudi Arabia, where obesity and diabetes are highly prevalent. Improving outcomes requires a multifaceted strategy that includes enhanced clinician training, standardised reporting practices, integration of risk stratification tools, improved access to lifestyle support and public health initiatives. Recognising incidental ultrasound findings as a marker of systemic metabolic dysfunction rather than a benign radiological observation is central to enabling timely intervention. Addressing clinical and system-level barriers may reduce the long-term burden associated with NAFLD and imp