[Non alcoholic fatty liver disease assessment]

Non alcoholic Fatty Liver Disease (NAFLD) is the leading cause of consultation in hepatology department. It is a manifestation of the metabolic syndrome. If the simple steatosis is considered as benign, Non Alcoholic Steato Hepatitis (NASH) is associated with increased mortality linked to cardiovascular, metabolic and liver diseases. The diagnosis of NAFLD is based on simple clinical and biological data often corroborated by a liver imaging. The main issues in the assessment of these diseases are firstly to exclude secondary causes of steatosis and secondly to establish the severity of the disease. The assessment of the severity of NAFLD implies the determination of the degree of fibrosis. Combination of biological tests and elastography allows to determine indirectly fibrosis, reserving liver biopsy for doubtful cases. Comorbidities associated with metabolic syndrome (insulin resistance and cardiovascular diseases) must be researched and screening measures for colon and breast cancers should be considered. Eventually, NASH monitoring should include, like for others chronic hepatitis, the screening for the complications of end-stage liver diseases, including portal hypertension and hepatocarcinoma.