[Management of non alcoholic fatty liver diseases in adults]

Nonalcoholic fatty liver diseases (NAFLD) are the commonest liver diseases. Usually asymptomatic, NAFLD are diagnosed because of abnormal liver function tests or hepatic imaging studies, or only in an advanced stage (cirrhosis, hepatocellular carcinoma). Fatty liver is diagnosed by imaging studies (ultrasound, even MRI), causal context (mainly metabolic syndrome, type 2 diabetes), and the elimination of the other causes of chronic liver disease and steatosis (alcohol firstly). The liver severity of the disease depends on the presence of inflammatory lesions (steatohepatitis) generating fibrosis. Steatohepatitis and severe fibrosis can often be adequately predicted by noninvasive methods (scores, Fibroscan). Liver biopsy remains necessary when multiple causes of liver disease coexist, or when noninvasive methods give discordant results. The diagnosis of NAFLD requires triple evaluation, hepatic, metabolic, and cardiovascular. Clinical follow-up of patients with NAFLD may be annual, or semiannual in case of cirrhosis. Hepatocellular carcinoma screening is indicated in the presence of cirrhosis, and perhaps in the absence of cirrhosis when other cofactors are present (age, male sex, type 2 diabetes).