A 48-year-old woman presents to the clinic for evaluation of abnormal liver function tests found during routine screening. She reports fatigue and occasional discomfort in the right upper quadrant but denies nausea, vomiting, or jaundice. She has a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia. She denies alcohol consumption and has no history of viral hepatitis or significant medication use. On examination, she has no signs of jaundice, hepatomegaly, or stigmata of chronic liver disease. Laboratory results show: • ALT: 58 U/L (elevated) • AST: 42 U/L (elevated) • Fasting glucose: 135 mg/dL • HbA1c: 7.4% • Lipid profile: Elevated triglycerides and low HDL cholesterol Abdominal ultrasound reveals increased echogenicity of the liver, consistent with fatty infiltration. Transient elastography (FibroScan) shows mild liver stiffness, suggesting early fibrosis. She has lost 3% of his body weight in the last 6 months through lifestyle changes. His BMI is 30 kg/m², and his liver enzymes remain elevated. What is the next best step in his management?
