 Non-alcoholic fatty liver disease, NAFLD, characterized by excessive fat accumulation, is the leading cause of chronic liver disease globally, including in Korea, where its prevalence among children increased from 8.2% to 12.1% between 2009 and 2018. Early screening for pediatric NAFLD requires laboratory tests such as aspartate aminotransferase and alanine aminotransferase, biomarkers like hepatic steatosis index, triglyceride glucose index and fibrosis 4 index, and imaging studies including ultrasonography and magnetic resonance imaging. Insulin resistance plays a major role in the pathogenesis of NAFLD, which is associated with diabetes mellitus, metabolic syndrome, and other health issues. This review focuses on the epidemiology, investigation, and association between NAFLD and insulin resistance and metabolic syndrome in pediatric patients. This article was authored by Kyeongchul Song, Ho Sung Kim, and Hyun Wook Chai. We are article.tv, links in the description below.