Objective To investigate the prevalence,incidence,death causes and natural course of nonalcoholic fatty liver disease (NAFLD) as well as the risk factors of NAFLD development in population of Guangdong province.Methods On the basis of previous epidemiological survey in 2005,3545 subjects were followed up (medium 4 years) for death causes.Of which,624 subjects (re-survey group) received interview,physical examinations,biochemical tests and ultrasonography again.The natural course and the risk factors of the NAFLD were analyzed.Results Of 3543 subjects,219subjects were failed to followed up and 4 out of 467 NAFLD patients (8.6‰) died of cardiovascular and cerebrovascular diseases during follow-up period.In rest 2857 subjects,22 (7.7‰) died of cardiovascular/cerebrovascular diseases and cancers.However,there were 117 NAFLD patients in resurvey group at the baseline.The NAFLD remained in 51 (43.6%) patients,aggravated in 26 (22.2%),alleviated in 21 (18.0%) and regressed in 19 (16.2%) at the endpoint.Meanwhile 185(36.5 %) out of 507 normal subjects developed NAFLD at the endpoint.The standard prevalence of NAFLD increased from 10.5% (2005) to 22.6% (2009,P<0.05).The standard incidence was 4.9% per year with male (5.1%) being higher than female (4.7%,P<0.05).The cumulative incidence was significantly higher in urban cities (43.1%) than in rural areas (27.4%,P<0.05).Cox proportional hazards regression showed that the age (OR= 1.893),waist circumference (OR=2.512),waist-to-hip ratio (WHR,OR= 1.400),body mass index (BMI,OR=2.581) and serum cholesterol levels (OR = 1.587) were associated with the development of NAFLD (P < 0.05).Multivariate regression logistic analysis revealed that age and BMI were associated factors for NAFLD.Decreased waist circumference was prone to remission.Conclusions The higher prevalence and incidence of NAFLD were noted in population of Guangdong province.The NAFLD patients mainly died of cardiovascular/cerebrovascular diseases,but not liver disease.Obesity,aging and dyslipidemia are high risk factors for NAFLD development.