Screening for non-alcoholic fatty liver disease (NAFLD) is a matter of controversy. NAFLD does fulfil some of the Wilson and Jungner classic screening criteria. It is undoubtedly an important health problem that affects at least 25% of the adult population worldwide and can result in cirrhosis and hepatocellular carcinoma. The pre-cirrhotic stage represents a latent stage where intervention may make a difference in the natural history of the disease. Non-invasive tests for NAFLD and liver fibrosis are available, acceptable and can be repeated as a continuing process. The target population for treatment – nonalcoholic steatohepatitis (NASH) with at least significant fibrosis – has been accepted by regulators and researchers. In contrast, although numerous studies have examined the natural history of NAFLD, there is much variability in the disease progression at the individual level, and the prediction of progression is far from perfect. Besides, one should remember that the majority of patients with NAFLD are seen by primary care physicians and endocrinologists instead of hepatologists, the facilities for diagnosis and treatment outside hepatology settings may not be widely available. More importantly, for a screening programme to impact on outcomes, case finding should translate into appropriate management that in turn improves clinical outcomes. As the field still lacks a registered drug for NASH, lifestyle advice or intervention remains the mainstay of treatment after the diagnosis of NAFLD. The introduction of the first drug for NASH will drastically change the effectiveness and cost-effectiveness of screening.