Subjects will then undergo a percutaneous liver biopsy to establish diagnosis of NASH. This will occur in the Gastroenterology Clinic at Brooke Army Medical Center. The liver tissue will be submitted to BAMC Pathology Department for evaluation by an AI, an experienced hepatopathologist. The pathology results will be used to identify subjects who have the more severe form of NAFLD, NASH. The pathologist will provide an overall diagnostic interpretation based on the criteria reported by Brunt et al. and by the NAFLD Activity Score (NAS). According to this scoring system, the degree of steatosis and inflammatory activity is measured using a zero to eight scale (steatosis=0-3; lobular inflammation=0-3; ballooning=0-2). The NAS is the unweighted sum of steatosis, lobular inflammation, and hepatocellular ballooning scores. The stage of fibrosis will be assessed using a zero to four scale (0=no fibrosis; 1=mild/moderate zone three perisinusoidal fibrosis, or portal/periportal fibrosis only; 2= perisinusoidal and portal/periportal fibrosis; 3= bridging fibrosis; 4= cirrhosis). Additionally, at the time of liver biopsy, 4 additional unstained slides will be prepared for morphometry analysis by Echosens. The liver histological diagnosis will be established by an experienced pathologist blinded to the clinical characteristics of the subjects, radiographic studies and the serum biomarkers. The outside expert pathologist will use the same scoring system as the local pathologist. If there is a discrepancy between the two pathology results for a subject the final determination will be made by the local BAMC pathologist. An addendum will be placed in the electronic medical record by the BAMC pathologist. The subject will be informed of the change and documentation of the new diagnosis and any further treatments will be made in AHLTA.