Abstract
Nonalcoholic fatty liver disease (NAFLD) is a multi-system disease, and metabolic syndrome, type 2 diabetes, and NAFLD interact as both cause and effect. Deaths caused by cardiovascular diseases and malignant tumors are the adverse outcome of patients with NAFLD and nonalcoholic steatohepatitis (NASH), and increased deaths caused by liver disease is mainly seen in NASH patients. There is a causal relationship between NASH and hepatocellular carcinoma, and almost 50% of patients with NASH-associated hepatocellular carcinoma do not have liver cirrhosis. At present, cohort studies on the natural history of NAFLD in China should be enhanced in order to provide a basis for the development of health strategies and prevention and treatment measures. This editorial elaborates on the association of NAFLD with diabetes, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma from the perspective of clinical epidemiology, in order to emphasize the importance of the natural history of NAFLD.