Non-alcoholic fatty liver disease (NAFLD) is defined as an abnormal accumulation of macrovesicular fat in the liver without known etiological causes. It is a broad term encompassing a wide spectrum of hepatic disorders ranging from simple steatosis to steatohepatitis (NASH), fibrosis, and eventually cirrhosis. Over the years, NAFLD has emerged as the leading cause of liver diseases in the pediatric population.1 Its prevalence in children is estimated to be 13%, with an age-dependent increase varying from <1% in children 2-4 years of age up to 17% in the adolescents. Overall incidence of NAFLD in children has increased over the past decade. Obesity is cited as the most important risk factor for NAFLD in children. In fact, majority of children with NAFLD are either overweight or obese. However, there is a subset of pediatric population with NAFLD that has abnormal body mass index, therefore referred to as “lean NAFLD”, suggesting possible involvement of additional factors that may contribute to NAFLD risk in children.2 Studies have suggested a genetic association in pediatric NAFLD development, as evidenced by NAFLD clustering in families. Also there is some data to show influence of the child’s intrauterine environment in NAFLD development. Low birth weight and high birth weight infants appear to have greater risk of NAFLD compared to normal birth weight children.