Background: Non-alcoholic fatty liver disease (NAFLD) is considered the most common chronic liver pathology.  There are many non-invasive ways for evaluating hepatic steatosis and fibrosis either laboratory or radiologically.
Objectives: To evaluate the correlation between laboratory biomarkers, ultrasonographic findings, transient elastography and controlled attenuation parameters in patients with (NAFLD).
Patients and methods: This cross-sectional study was carried out on 100 persons with NAFLD as determined by transabdominal ultrasound. A complete history, physical examination, and laboratory tests were done, besides pelviabdominal ultrasound scan. To evaluate the hepatic stiffness, transient elastography (TE) were utilized. Control  Attenuation parameters (CAP), and liver stiffness measurements (LSM) and were evaluated. Grades concerning fatty liver and stiffness were determined for every patient by the following specific related equations: Fatty Liver Index [FLI], Hepatic Steatosis Index [HSI], and finally the Nonalcoholic fatty liver disease fibrosis score [NFS].
Results: We found that LSM and CAP were significantly increased in patients with grade III fatty liver disease (7.5 ± 2.1) (296.8 ± 43.8) when compared with those with grade II fatty liver disease (5.8 ± 1.8) (236 ± 1.8), and patients with grade I fatty liver disease (5.5±1.1) (169.8±35.8) respectively (p value < 0.001). Patients with grade III fatty liver disease had a statistically significant increase in NAFLD fibrosis score (p value = 0.027) and fatty liver index (p value < 0.001) compared with patients with grade II and grade I fatty liver disease.
Conclusions: The findings of  LSM and CAP parameters of TE were significantly and positively correlated to ultrasonographic NAFLD stage. There was a significant positive correlation between liver fibrosis outcomes (FLI and NFS) and US NAFLD stage.