A systematic review and meta-analysis of cohort studies from Mainland China, Hong Kong, South Korea, Japan, Sri Lanka and Israel of adults at risk without nonalcoholic fatty liver disease (NAFLD) at baseline (n = 1,201,807) evaluated the incidence of ultrasound-diagnosed NAFLD. The incidence rate was estimated at 46.13 (95% CI 3,931.5–5,294.2) per 1,000 person years and is increasing (median study year 2000–2016). Individuals with overweight or obesity and smokers had increased incidence rates compared with people with normal weight and nonsmokers (P < 0.0001 and P = 0.046, respectively).