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Non-alcoholic fatty liver disease (NAFLD) encompasses a variety of diseases ranging from simple steatosis or fatty liver through non-alcoholic steatohepatisis (NASH) to fibrosis that can eventually lead to irreversible cirrhosis. NASH was first described by Ludwig et al. (Ludwig et al., 1980) in a number of patients who reported no “significant” alcohol intake but whose liver histology resembled that of alcoholic liver disease. Today the term NAFLD is used either when referring to a full spectrum of liver disease or when the aetiology of the disease is unknown, excluding secondary causative factors such as excessive alcohol intake, hepatotoxic drugs, metabolic/genetic and other liver diseases (for instance autoimmune or viral hepatitis) (Treeprasertsuk et al., 2011). The occurrence of NAFLD has been persistently increasing in parallel with the concerning worldwide epidemic of obesity and diabetes and is expected to rise in the future (Portincasa et al., 2005). In the Western countries NAFLD is already becoming the most common cause of liver disease with the estimates of prevalence being between 17 and 33 % in the general population (McCullough, 2005) and rising as high as 90 % in morbidly obese individuals (Machado et al., 2006). NASH, the most severe and clinically significant form of NAFLD, is less common and is expected to be present between 5.7 and 17 % of the population (McCullough, 2005), again the numbers increase in the morbidly obese (up to 37 %) (Machado et al., 2006). Although NAFLD can occur in lean patients, the majority of the patients are overweight or obese (McCullough, 2005). Of particular concern, especially in the view of the future disease burden, is the presence of NAFLD in children and adolescents. For instance, the prevalence of obesity among US children has tripled in just one decade, rising from 5 % in 1980 to 15 % in 1990 and is currently around 17 %(Centers for Disease Control and Prevention CDC, 2011). The estimates of NAFLD prevalence in childhood have risen accordingly and are already between 2.6 and 9.6 % among the general pediatric population (Pacifico et al., 2010), reaching 68 % in obese children (Fu et al., 2011). Most cases of NAFLD arise in the detrimental environment of various metabolic disorders commonly known as the metabolic syndrome. The disease is strongly associated with insulin resistance, hypertension, glucose intolerance, central obesity and dyslipidemia and is thus recognized as the hepatic manifestation of the metabolic syndrome (Marchesini et al., 2005). Simple steatosis is largely benign and has a good prognosis. Nevertheless, a significant

Cholesterol and Inflammation at the Crossroads of Non-Alcoholic Fatty Liver Disease (NAFLD) and Atherogenesis