Pathologist's observations have remained central to the evolution of the field of non-alcoholic fatty liver disease, even with the advent of increasingly effective non-invasive markers of advanced fibrosis. As the field matures, the role of pathology has also shifted from being largely descriptive to being confirmatory and diagnostic, as well as providing semi-quantitative evaluation of specific findings, particularly in therapeutic interventional trials. Some newly appreciated histopathological findings will be discussed in this review.