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非酒精性脂肪性肝病和酒精（乙醇）相关性肝病是全球范围内流行的慢性肝病，是造成脂肪肝的主要原因。非酒精性脂肪性肝病患者也会有不同形式的饮酒，肥胖与饮酒共存时脂肪肝的病因诊断更加困难。饮酒量和饮酒模式与慢性肝损伤、2型糖尿病、心血管疾病等多种代谢相关疾病间可能存在“J”型关系，即少量～适量饮酒可能对上述疾病带来一定的益处，但过量饮酒可能促进肥胖发展，加重肝病和代谢异常，增加发生肿瘤的风险。当肥胖与饮酒共存时，除评估肝脏病变情况外，也应重视筛查代谢相关疾病的风险。改变不良生活习惯，减重和限酒仍然是治疗脂肪肝和代谢紊乱的基础，对于有药物治疗指征的患者，充分考虑利弊及与患者充分沟通后可以慎重选择。终末期患者可以考虑肝移植，术后亦应重视改善生活方式。“,”Non-alcoholic fatty liver disease and alcohol (ethanol)-related liver disease is a global epidemic of chronic liver disease and the main cause of fatty liver. Non-alcoholic fatty liver patients sometimes ingest different types of alcohol. Therefore, when obesity coexist with alcohol consumption, it is more difficult to diagnose the cause of fatty liver. The amount of alcohol consumption and alcohol drinking pattern and chronic liver injury, type 2 diabetes mellitus, cardiovascular disease and other metabolic-related diseases may have J-type correlation; that is to say, a light to moderate amount of alcohol consumption may bring certain benefits to the above diseases, but excessive alcohol consumption may promote the development of obesity, aggravate liver disease, metabolic abnormalities, and increase the risk of tumors. Screening for metabolic-related disease risk should be considered in addition to the assessment of changing liver lesions when obesity coexists with alcohol consumption. Changing bad living habits, losing weight and abstaining from alcohol are still the basis of treating fatty liver and metabolic disorders. Carefully selecting patients and communicating with them about the risk and benefit of drugs are important indicators of drug therapy. Patients with end-stage liver disease can be considered for liver transplantation and postoperative lifestyle improvement should be emphasized.