Non-alcoholic fatty liver disease (NAFLD) is the most highly prevalent chronic liver condition and is associated with significant adverse outcomes, both through liver-specific morbidity and mortality, but perhaps more importantly, through adverse cardiovascular and metabolic outcomes. NAFLD is a spectrum of disease, extending from simple steatosis, through to inflammation and fibrosis and risk of cirrhosis. The mechanisms that govern hepatic lipid accumulation and the predisposition to inflammation and fibrosis represent a complex interplay between metabolic target tissues including adipose and skeletal muscle, and immune and inflammatory cells. NAFLD is tightly associated with type 2 diabetes and obesity, both driving progressive disease towards the most advanced stages. It is also associated with other endocrine conditions including hypogonadism in men and polycystic ovary syndrome in women. Accurate diagnosis and staging are crucial as they provide prognostic information that impacts upon clinical management. Liver biopsy is still regarded as the gold-standard investigative tool; however, there are now an array of novel non-invasive biomarkers and imaging modalities that aim to accurately reflect the stage of underlying disease and their use will be discussed. Licensed therapies for NAFLD are currently lacking, although data are emerging from phase 3 clinical studies indicating that specific liver-targeted therapies are close to becoming available. Our current strategy is to advocate an holistic, multidisciplinary approach to patient management, combining aggressive lifestyle intervention to promote weight loss with cardiovascular risk reduction, focussing on blood pressure control, hyperlipidaemia, smoking cessation and optimization of blood glucose control (preferentially using agents with a positive impact on weight, liver, cardiovascular risk as well as glycaemic control).