Description: Background: Non alcoholic fatty liver disease (NAFLD) is associated with increased risk of type 2 diabetesand chronic liver disease but identifying patients who have NAFLD without resorting toexpensive imaging tests is challenging. In order to help identify people for imaginginvestigation of the liver who are at high risk of NAFLD, our aim was to: a) identify easilymeasured risk factors at baseline that were independently associated with incident fatty liverat follow up, and then b) to test the diagnostic performance of thresholds of these factors atbaseline, to predict or to exclude incident fatty liver at follow up. Methods: 2589 people with absence of fatty liver on ultrasound examination at baseline were reexaminedafter a mean of 4.4 years in a Korean occupational cohort study. Multi-variablelogistic regression analyses were used to identify baseline factors that were independentlyassociated with incident fatty liver at follow up. The diagnostic performance of thresholds ofthese baseline factors to identify people with incident fatty liver at follow-up was assessedusing receiver operating characteristic (ROC) curves. Results: 430 incident cases of fatty liver were identified. Several factors were independentlyassociated with incident fatty liver: increased triglyceride (per mmol/l increase) OR 1.378[95%CIs 1.179, 1.611], p 〈 0.0001; glucose (per mmol/l increase) OR 1.215 [95%CIs 1.042,1.416], p = 0.013; waist (per cm increase) OR 1.078 [95%CIs 1.057, 1.099], p 〈 0.001; ALT(per IU/L increase) OR 1.009 [95%CIs 1.002, 1.017], p = 0.016; and platelets (per 1x109/Lincrease) OR 1.004 [1.001, 1.006], p = 0.001; were each independently associated withincident fatty liver. Binary thresholds of the five factors were applied and the area under theROC curve for incident fatty liver was 0.75 (95%CI 0.72-0.78) for the combination of allfive factors above these thresholds. Conclusion: Simple risk factors that overlap considerably with risk factors for type 2 diabetes allowidentification of people at high risk of incident fatty liver at who use of hepatic imaging couldbe targeted.