Non-alcoholic fatty liver disease (NAFLD) is a prevalent chronic non-infectious liver disease nationwide that can progress to liver cirrhosis and liver cancer, posing a significant threat to human health. Under hypoxic conditions at high altitudes, various organs and systems of the body are affected. Liver tissues, in particular, experience intensified hypoxia, leading to a significantly higher prevalence of NAFLD in plateau areas than in sea level areas. Currently, there are diverse opinions on the pathogenesis of NAFLD, and the specific mechanisms by which high-altitude hypoxia promotes NAFLD progression remain unclear. In this article, we review the impact of high-altitude hypoxia on liver parenchymal cells and mesenchymal cells, consolidate relevant research findings, and summarize the potential mechanisms by which high-altitude hypoxia may contribute to the progression of chronic NAFLD, providing new insights for the prevention and treatment of NAFLD.