Patients presenting with suspected or known NAFLD who were undergoing a standard of care liver biopsy to diagnose and/or to assess the severity of the disease were enrolled in this study. All subjects were enrolled between 2012 and 2016 at a single tertiary care medical center. The study was approved by the institutional review board of Virginia Commonwealth University, and all subjects provided informed consent. All research was performed in accordance with the guidelines and regulations of the review board and the publisher. The liver biopsy was performed using a percutaneous approach or a transjugular approach in all instances. At the time of the biopsy, 1.5–2 cm core of tissue of 16 gauge diameter was sent for histological assessment and 2–5 mm of tissue was snap-frozen in liquid nitrogen at the bedside within five minutes of obtaining the biopsy. Those with biopsy-proven NAFLD were included for this analysis. Control subjects included those who had normal liver histology and did not have evidence of other common etiologies for liver disease such as hepatitis B and C, hemochromatosis, alcohol-associated liver disease. These subjects were either donors for living donor transplant or had a prior history of ALT fluctuations that was evaluated with a liver biopsy.
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