Diagnosis of NAFLD History (presence of risk factors, absence of excessive alcohol intake) Serologic tests that rule out hepatitis B and C Ultrasound evidence of steatosis or MR elastography with fat fraction Liver biopsy The diagnosis of NASH should be suspected in patients with metabolic syndrome (typically obesity, type 2 diabetes mellitus or a high fasting plasma glucose level, hypertension, and dyslipidemia) and in patients with unexplained laboratory abnormalities suggesting liver disease.