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Referral to specialist hepatology services is recommended if: There is evidence of advanced fibrosis (e.g., ELF score 10.51, high liver stiffness on transient elastography) Liver enzymes remain persistently elevated despite lifestyle modification There is uncertainty about the underlying cause of liver disease The patient has decompensated liver disease or complications of cirrhosis Regular engagement with primary care, adherence to lifestyle changes, and appropriate monitoring help track disease progression and treatment response

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The cohort was 82.4% female, with a median age of 52

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