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Background: Evidence indicates that certain healthy lifestyle factors are associated with non-alcoholic fatty liver disease (NAFLD). However, little is known about the effect of combined healthy lifestyle factors. Objective: To assess the association of combined healthy lifestyle factors with the incidence of NAFLD. Methods: This cohort study was conducted in Changsha, Hunan Province, China. The healthy lifestyles factors studied were not being a current smoker, having a healthy diet, engaging in physical activity, having a normal body mass index (BMI) and engaging in non-sedentary behavior. NAFLD was diagnosed based on abdominal ultrasonography. Logistic regression models were conducted to investigate the associations being studied. Results: Of the 5411 participants, 1280 participants had NAFLD, with a prevalence of 23.7% at baseline. The incidence of NAFLD among participants without NAFLD at baseline was found to be 7.2% over a mean follow-up of 1.1 years. Compared with participants with 0–1 low-risk factors, the OR of NAFLD was 0.50 (95% CI: 0.29–0.82, p = 0.008) for those with at least 4 low-risk factors. Similar associations were observed in subgroup analyses and sensitivity analyses. Conclusion: This study suggests that a combined healthy lifestyle pattern may considerably decrease the risk of NAFLD in Chinese government employees.

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