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The first aim for a primary care provider is to identify which patients with NAFLD have advanced liver fibrosis and refer further workup and management to specialists. Most patients with NAFLD do not have advanced liver fibrosis or disease and many will not progress to NASH. For patients with NAFLD and no significant fibrosis, the primary care provider plays a critical role in the holistic management of the metabolic syndrome to mitigate cardiovascular, metabolic, and other nonliver pathology. For those patients with nonalcoholic steatohepatitis, specialist care will be important for the introduction of therapies as they are approved. It is likely that some of these therapies will transfer to primary care over time whereas more involved therapies, such as induction antifibrotics, will continue to be administered by specialists.