Background <p>Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of elevated liver enzymes encountered in the practice of hepatology and an important predisposing factor for chronic liver disease. Fatty infiltration of the liver parenchyma occurs with variable degrees in NAFLD, ranging from simple hepatic steatosis up to cirrhosis, and hepatocellular carcinoma.</p> Purpose <p>The rationale behind the study is to evaluate and compare the hepatic hemodynamic indices measured by ultrasound and Color Doppler to the different quantified degrees of fibrosis and steatosis measured by transient elastography.</p> Results <p>In this cross-sectional study, twenty-eight females (70%) and twelve males (30%) with NAFLD were involved. Fatty liver severity was graded by sonography (sonography steatosis grade) and FibroScan® (S score), and liver fibrosis was graded through FibroScan® (F stage). Changes to the portal, hepatic, and splenic veins were evaluated by color Doppler. A significant association between sonography steatosis grade and F stages (<i>p</i> &lt; 0.001) was revealed. In addition, a significant association existed between the sonography steatosis grade and the S score (<i>p</i> &lt; 0.001). Among Color Doppler findings, there were statistically significant differences in mean portal vein resistivity index (RI) among the S score (<i>p</i> = 0.007) and the sonography steatosis grades (<i>p</i> = 0.005), and in mean splenic vein RI among the F stages (<i>p</i> = 0.021)<i>.</i></p> Conclusion <p>Color Doppler ultrasonography and hepatic transient elastography complement each other in understanding the degree of hepatic parenchymatous and hemodynamic changes, offering useful insights about the severity of the disease, which likely has valuable clinical implications in terms of treatment and follow-up.</p>