Objective To investigate the prevalence and major risk factors for fatty liver disease among adult residents in Yan'an,Shanxi Province,China.Methods The study enrolled healthy adults who had physical examination with complete clinical records in our hospital from February 2011 to March 2013.All participants underwent anthropometric measurement(height,weight,and blood pressure),biochemical and immunological tests(liver and renal function; blood glucose,lipids,and uric acid [UA]; viral markers),and ultrasound examination.Data analysis was performed using the t test,χ2test,and logistic regression analysis.Results A total of 6236 adult residents participated in the survey,who accounted for approximately 3.76 /1000 of the total population in Yan'an.There were 3532 males and 2704 females,with a mean age of 49.27 ± 12.93 years.Fatty liver disease was detected with ultrasound examination in 1602 participants(25.68%),among whom alcoholic,suspected alcoholic,and nonalcoholic forms accounted for 4.55%,7.08%,and 88.37%,respectively.The fatty liver group had a significantly higher prevalence of obesity,hypertension,hyperuricemia,higher-than-normal fasting serum glucose(FSG) level,diabetes mellitus,and dyslipidemia than the non-fatty-liver group(P < 0.001).Multiple regression analysis showed that age,gender(male),drinking,waist circumference,body mass index,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG),UA,FSG,diabetes mellitus,and hypertension were influential factors for fatty liver disease,of which HDL-C was a protective factor.Compared with the normal FSG group,the impaired fasting glycaemia and diabetes groups were at an increased risk for fatty liver disease by 1.584-and 2.638-fold,respectively(P < 0.001).The risk increased by1.627-,1.796-,9.544-fold,respectively,in the overweight,grade I obesity,and grade Ⅱobesity groups versus the normal weight group(P< 0.001),by 1.638-and 3.648-fold in the moderate and heavy drinking groups versus the non-drinking group(P < 0.001),and by17.672-fold in the obesity plus drinking group versus the non-obesity or drinking group(P < 0.001).Moreover,the elevated systolic blood pressure,diastolic blood pressure,UA,TG,total cholesterol,and LDL-C groups and the reduced HDL-C group were at a significantly greater risk for fatty liver disease than the normal group,showing 1.835-,1.768-,1.821-,4.524-,1.569-,1.824-,and2.724-fold differences,respectively(P < 0.05).Abnormal TG and HDL-C levels were associated with the most significantly increased risk.Conclusion There is a high prevalence of fatty liver disease(mainly in a nonalcoholic form) among adult residents in Yan'an.Gender,age,obesity,drinking,disorder of glucose metabolism,hyperuricemia,hypertension,and hyperlipidemia are the major risk factors for this disease in the study area.