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The scarring can progress to cirrhosis, which is the last stage of non alcoholic fatty liver disease. The risk factors, the time-line, and the processes (mechanisms) responsible for progression through the stages of non alcoholic fatty liver disease are still unclear. Estimates of the number of cases of non alcoholic fatty liver disease among insulin resistance / complications the obese and insulin resistance / complications patients with diabetes mellitus type 2 (DM2) suggest that 90% have fatty liver, 20% have non alcoholic steatohepatitis, and 10% have cirrhosis. Among those with cirrhosis, liver cancer insulin resistance / complications develops in approximately 1% to 2% of patients per year. The presumptive diagnosis of non alcoholic fatty liver disease or non alcoholic steatohepatitis is made in individuals who are insulin resistant, have mildly elevated liver enzymes in the blood, and have signs of fatty liver on an ultrasound. These patients must have no other cause for the abnormal enzymes or for the fatty liver, particularly no excessive use of alcohol.
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