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Over the last few decades, aquaculture has undergone a dramatic expansion in production, becoming a key source of food for people in many countries. Indeed, aquaculture has become extremely important for food security. However, the rapid expansion has led to many concerns, such as the effects of water shortages, pollution, disease and the depletion of natural fish stocks used as protein and fat sources for aquaculture diets. Against this backdrop, there has been a growing awareness of the need for sustainability to ensure the long-term future of aquaculture. Thus, there have been tremendous efforts made to incorporate the latest procedures to ensure sustainability. For example, the industry has not been slow to address the benefits of polyculture, offshore rather than coastal sites for mariculture, the use of aquaponics and land-based recirculation systems, and improved disease management, including mitigation against the adverse effects of pollution, such as the use of biofloc technology. The therapeutic approach to disease control has moved towards prophylaxis, notably immunoprophylaxis and the use of probiotics and phytobiotics. Unfortunately, there are challenges resulting from the effects of environmental change, i.e. global warming. Some solutions have been found by use of new technologies, including nanotechnology. All these aspects are considered in this review.