Non-alcoholic fatty liver disease (NAFLD) in individuals with normal body mass index (BMI), known as lean NAFLD, is emerging as a silent epidemic, especially in Asian populations including India. Despite normal weight, these individuals present metabolic abnormalities and liver damage. This article maps current evidence on lean NAFLD with an emphasis on its prevalence, pathophysiology, diagnosis, management, and the unique role of nurses in the Indian context. A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Literature published from 2015 to 2024 was searched in PubMed, Scopus, and Google Scholar using terms such as ‘lean NAFLD’, ‘non-obese fatty liver’, ‘India’, and ‘nursing intervention’ with Boolean operators. Studies relevant to the Indian population and nursing practice were prioritised. Lean NAFLD shows high prevalence in India despite low BMI profiles. It is associated with insulin resistance, visceral adiposity, and increased risk of cardiovascular and liver-related morbidity. Nurses are critical in screening, educating, and managing affected individuals, especially within non-communicable disease (NCD) frameworks. This review underscores the need for early identification strategies and nurseled interventions to manage lean NAFLD in India. Integration into national health programmes and continuous nursing education are essential.