There is a high incidence and prevalence of Non-alcoholic fatty liver disease (NAFLD) among Sri Lankan adults and adolescents. NAFLD increases the risk of incident diabetes.Lean NAFLD is rarer but is as important as overweight NAFLD metabolically. Both types are associated with PNPLA3 polymorphisms. NAFLD is unlikely to resolve without supervised sustained lifestyle change, and mortality in NAFLD is associated with being metabolically abnormal. The proposed disease acronym Metabolic associated fatty liver disease (MAFLD) seems to improve clinical utility. Currently research activities have been expanded to investigate non-invasive tests to diagnose significant hepatic fibrosis and other complications associated with NAFLD.