By using state-of-the-art non-invasive tests of hepatic steatosis and fibrosis, we aimed to study the incidence of NAFLD in the general population and risk factors of incident NAFLD. Methods: Community subjects were recruited via the government census database by random sampling and underwent serial Nivolumab supplier assessments. Proton-magnetic resonance spectroscopy was performed to measure intrahepatic triglyceride content, with a cutoff of 5.0% being used to define fatty liver. Transient elastography by Fibroscan was performed to measure liver stiffness, with a cutoff of 9.6 kPa being used

to define advanced fibrosis. Results: 565 subjects with normal intrahepatic triglyceride content (<5.0%) at baseline underwent follow-up assessment after a median interval of 47 months (range 34-60

months). The mean age at baseline was 48 years, 62.7% were women, and the body mass index was 21.9 (SD 2.9) kg/m2. 78 (13.8%) subjects developed incident fatty liver with a mean intrahe-patic triglyceride content of 8.9% (SD 5.3%) at follow-up. After excluding 2 men with significant alcohol consumption, the population incidence of NAFLD at 3-5 years was 13.5% (95% CI 10.6-16.3%; 3.4% per year). Only 1 subject with incident NAFLD had high liver stiffness by transient elastography (11.1 kPa) suggestive of advanced fibrosis. After adjusting for age, gender, smoking and insulin resistance, metabolic syndrome check details at baseline increased the risk of incident fatty liver by 4.56 fold (95% CI 2.34-8.90). The rs738409 GG variant in pata- tin-like Celecoxib phospholipase 3 (PNPLA3) gene was present in 16.7% of subjects with incident fatty liver and 9.9% of those without (P=0.14) Among 394

subjects with body mass index (BMI) <23.0 kg/m2 at follow-up, 33 (8.4%) developed fatty liver. Lean subjects with incident fatty liver had higher BMI, waist circumference and hemoglobin A1c at follow-up than those without. The alanine aminotransferase (ALT) level at follow-up was abnormal (>30 IU/L in men and 19 IU/L in women) in 51.3% of subjects with incident fatty liver and 30.6% of those without (P<0.001). Conclusions: 13.5% of Hong Kong Chinese adults develop NAFLD in 3-5 years. Metabolic syndrome is the most important risk factor of NAFLD. Incident NAFLD is uncommon in lean subjects and is usually due to central obesity. Alanine aminotransferase is an unreliable test for incident NAFLD. [Supported by the General Research Fund from the Hong Kong SAR Government (476512).] Disclosures: Vincent W.