Nasr P, et al. - Experts aspired to explore if conventional histological grading of steatosis and accurate quantification of fat content in liver biopsies utilizing stereological point counting (SPC) can anticipate mortality and future development of T2DM in nonalcoholic fatty liver disease (NAFLD) patients. One hundred twenty-nine patients with biopsy proven NAFLD, enlisted between 1988 and 1992, were re-evaluated on two occasions, after 13.7 (± 1.5) and 23.2 (± 6.8) years. Of the 106 individuals without T2DM at baseline, 66 developed T2DM during a mean follow-up of 23.2 (± 6.8) years. For patients with grade 3 steatosis, overall mortality and development of T2DM was more common compared with lower steatosis grades. SPC-measured steatosis grade and liver fat predict mortality and the risk of developing T2DM in NAFLD. Lowering the liver fat reduces the risk of developing T2DM.