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Background:   Referral to weight loss programmes is the only effective treatment for non-alcoholic fatty liver disease (NAFLD). Clinicians should advise weight loss and screen for liver fibrosis using the Enhanced Liver Fibrosis (ELF) score.   Aim:   To examine if the ELF score changes with weight loss.   Design and Setting:   Randomised controlled trial (ISRCTN85485463) in UK primary care during 2007–2008.   Method:   Adults with a BMI of 27–35 kg/m<sup>2</sup> and ≥1 risk factor for obesity-related disease were randomised to attend a community weight loss programme ( n  = 45) or receive usual weight loss advice from a practice nurse ( n  = 28). Weight and the ELF score were measured at baseline and 1 year. Analysis of covariance examined mean changes in the ELF score between groups and its relationship with weight loss.   Results:   Mean (SD) BMI was 31.10 kg/m<sup>2</sup> (2.55) with evidence of moderate levels of liver fibrosis at baseline (mean ELF score: 8.93 [0.99]). There was no evidence that the community weight loss programme reduced the ELF score compared with usual care (difference +0.13 points, 95% CI: –0.25 to 0.52) despite greater weight loss (difference: –2.66 kg, 95% CI: –5.02 to –0.30). Mean weight loss in the whole cohort was 7.8% (5.9). There was no evidence of an association between weight change and change in ELF; the coefficient for a 5% weight loss was –0.15 (95% CI: –0.30 to 0.0002).   Conclusion:   We found no evidence that the ELF score changed meaningfully following moderate weight loss. Clinicians should not use the ELF score to measure improvements in NAFLD fibrosis following weight loss programmes.

The Effect of Moderate Weight Loss on a Non-Invasive Biomarker of Liver Fibrosis: A Randomised Controlled Trial