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Accumulating evidences demonstrate that abnormalities in whole blood viscosity (WBV) have been implicated in insulin resistance which may lead to non-alcoholic fatty liver disease (NAFLD). However, epidemiological studies exploring the association between WBV and NAFLD were not available.Our objective was to evaluate the association between WBV levels and risk of prevalent NAFLD.This was a cross-sectional population-based study performed in Shanghai, China.A total of 8673 participants aged 40 years or older were included.WBV was calculated from haematocrit and plasma protein concentration, at a shear rate of 208−1 s, by a validated equation. NAFLD was diagnosed by hepatic ultrasound after the exclusion of alcohol abuse and other liver diseases. Insulin resistance (IR) was assessed by homeostasis model assessment (HOMA-IR).The overall prevalence of NAFLD was 30·2% in this population. With the increase of WBV level, participants have larger waist circumference (WC), more severe insulin resistance and the prevalence of NAFLD increased significantly with elevated WBV quartiles. Compared with those in the lowest quartiles, adults in the highest quartile of WBV levels have higher prevalence of NAFLD (adjusted odds ratio 1·77, 95% confidence interval [CI] 1·48–2·13) and IR (2·72, 95% CI 2·26–3·27).Elevated WBV is associated with prevalence of NAFLD and IR in middle-aged and elderly Chinese population.