Prevalence estimates of NAFLD in elderly cases varies from 12% from hospital based study with liver biopsy confirmation to 30-50% from population based studies by ultrasonography or transient elastography. Elderly NALFD cases had a higher prevalence of lean individuals (11% elderly group vs. 3.9% in non-elderly group). The increasing prevalence of advanced fibrosis in elderly NAFLD by noninvasive score were observed which enlightens the concerns of liver complications. Data from GO-ASIA study group showed that the factors associated with advanced fibrosis in elderly patients were female sex (OR 3.21; 95% CI 1.37–7.54) and hypertension (OR 3.68; 95% CI 1.11–12.23). Regarding to the clinical presentation and clinical outcomes, sarcopenic subjects were commonly found and may associated with significant liver fibrosis. Due to the limited number of studies of the elderly NAFLD, thus we need further studies to confirm this association. Finally, the noninvasive fibrosis scores which currently used to assess liver fibrosis such as FIB-4 and NFS. may be used in subgroup of the elderly population with the higher cut-off value due to the low specificity. For example, FIB-4 with cut-off >2.0 showed 77% in sensitivity and 70% in specificity for NAFLD patients aged >65 years. Additionally, Transient elastography can be used as a noninvasive tool to assess liver fibrosis in the elderly group, however the long-term follow up data are still limited. Studies on clinical outcomes among elderly NAFLD have shown varying outcomes. .A population-based study of elderly NAFLD with high risk of liver fibrosis according to NFS and FIB-4, had increased overall mortality and cardiovascular mortality compared to those elderly participants with low or intermediate risk, independent of comorbidities. Further studies are needed to confirm this outcome.