A fatty liver that is borderline enlarged and the enzymes are fine does that mean the person has nash ?

Not necessarily.: Usually there is some level of inflammation with NASH - usually seen with elevated enzymes. Fat infiltration of liver is on a spectrum. You have fatty liver - > then fatty liver w/ inflammation (nash) -> then fibrosis and scarring (cirrhosis). Fatty liver by itself is for the most part harmless, but it can progress so good diet, exercise and cholesterol control is key.