Aims: A number of clinical trials reported diverse effects of cholesterol- lowering agents in nonalcoholic fatty liver disease (NAFLD) patients. We, therefore, assessed the changes in non-alcoholic steatohepatitis activity score (NAS) and intrahepatic fat contents after treatment with cholesterol lowering agents in NAFLD patients by performing a meta-analysis. Methods: The Cochrane library, the MEDLINE, and the EMBASE databases were searched until June 2015, without any language restrictions, for randomized controlled trials (RCTs) and non-randomized studies (NRSs); additional references were obtained from reviewed articles. The quality of evidence was assessed using the grading of recommendations assessment, development and evaluation guidelines. Results: Three RCTs and three NRSs (235 participants) met the inclusion criteria for this updated systematic review. Liver biopsy was performed in three RCTs, but only the two studies reported NAS. Ezetimibe showed decreased NAS (Pooled RR: -0.65, 95% CI: -1.15 ~ -0.015). The intrahepatic fat contents were not decreased in RCTs, while they were decreased in NRSs. The baseline cholesterol level in all three RCTs was lower than the three NRSs (191mg/dl vs. 227.5mg/dl). The pre-planned secondary outcomes of AST, ALT, Glucose, HbA1c analysis did not show significant difference after treatment with cholesterol lowering agents. Conclusions: Ezetemibe decreased NAS score without improving intrahepatic fat contents.