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Non-alcoholic fatty liver disease (NAFLD) is a global public health problem and is the most common cause of chronic liver disease worldwide. The prevalence of NAFLD is approximately 30％, irrespective of ethnicity, and parallels the exponential rise of the obesity and diabetes epidemics. The active inflammatory and cell injury component of NAFLD, known as non-alcoholic steatohepatitis (NASH), increases the risk of liver-related mortality by 5 to 10 times;but this is largely dependent on the extent of fibrosis (1,2). Despite this, cardiovascular disease (CVD) and extra-hepatic malignancy remain the commonest causes of death in these cohorts. Therefore, non-surprisingly the last decade has seen the clinical focus switch from NAFLD as a solitary organ entity to a multi-systemic disease.