Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease affecting
approximately 25% of the global population. There is a strong association between the severity of NAFLD
and the components of the metabolic syndrome. NAFLD is also independently associated with cardiovascular
disease and type 2 diabetes mellitus (T2DM). The progressive potential of non-alcoholic fatty liver disease
(NAFLD) is indisputable today, and the histological spectrum of NAFLD ranges from isolated steatosis to nonalcoholic
steatohepatitis (NASH), with risk of developing fibrosis and subsequent cirrhosis and hepatocellular
carcinoma. There is a substantial inter-patient variation in disease progression, therefore, this review will focus on
potential modifiers of fibrosis progression, development of liver cirrhosis, decompensation and liver-related mortality.
The potential drivers of disease progression that is discussed are; T2DM and Insulin Resistance, body
weight, alcohol consumption, genetics (including HFE and alfa-1-antitrypsin) as well as histological features
predictive of disease progression.