Inclusion Criteria:  Patients were enrolled in the study  if they are > 18 years old had evidence for NASH; persistently elevated alanine aminotransferase (ALT) >1.5 times the upper limit of normal) imaging (ultrasound) showing fatty infiltration, and histological evidence of NASH after biopsy (macrovascular steatosis, ballooning degeneration of hepatocytes, scattered lobular inflammation and apoptotic bodies).  Exclusion Criteria:  Patients were ruled out if they had  history of alcohol dependence treatment with drugs known to induce NASH (e.g. amiodarone, calcium channel blocker, tamoxifen, oral anticoagulation, methotrexate , steroids and estrogen) positive serologic markers for known chronic liver diseases (hepatitis B surface antigen, anti-hepatitis C virus antibody antinuclear antibody) human immunodeficiency virus (HIV) infection Diabetes decompensated liver disease defined as serum bilirubin level >1 mg/dL, albumin level ˂3.5 g/dL, and international normalized ratio (INR) ≥1.7.