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Nonalcoholic fatty liver disease （NAFLD） is currently the main cause of chronic liver disease worldwide, and it can progress to hepatitis, liver fibrosis, liver cirrhosis, and even hepatocellular carcinoma. Although obesity plays a key role in the development of NAFLD, more and more studies have confirmed that NAFLD still exists in lean individuals, and lean NAFLD is associated with an increased risk of death and accelerated disease progression. Therefore, lean NAFLD also deserves careful evaluation and follow-up; however, we still know little about the pathophysiological mechanism of lean NAFLD. This article reviews the etiology, diagnosis, treatment, and prognosis of lean NAFLD. [ABSTRACT FROM AUTHOR]