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This study was carried out to evaluate the association between nonalcoholic fatty liver disease (NAFLD) and the development of hepatocellular carcinoma (HCC) between 2005 and 2015 in a hepatitis B virus (HBV)-endemic area.The medical records of 1327 patients initially diagnosed with HCC at our institution between January 2005 and December 2015 were analyzed retrospectively. Patients with other malignancies in addition to HCC were excluded. During the study period, changes in the proportion of NAFLD-associated HCC among all HCCs were assessed longitudinally. In addition, the clinical characteristics of NAFLD-associated HCC were evaluated.Among the 1327 patients, HBV was the most common (65.5%) cause of HCC, and the overall rate of NAFLD-associated HCC was 4.7%. Compared with HBV-associated HCC patients, NAFLD-associated HCC patients were older, had a higher median body mass index, and a larger median tumor size (P<0.05 for all). Liver cirrhosis was less frequent in NAFLD-associated than in HBV-associated HCC patients (P<0.05). The annual proportions of NAFLD-associated HCC patients were 3.4% in 2005, 3.6% in 2006, 3.5% in 2007, 3.2% in 2008, 4.2% in 2009, 4.4% in 2010, 5.6% in 2011, 5.2% in 2012, 5.8% in 2013, 7.0% in 2014, and 6.7% in 2015. From 2008 to 2015, these percentages increased steadily.The annual proportion of NAFLD-associated HCC patients among all HCC patients ranged from 3.2 to 3.5% before 2008, but thereafter, it increased gradually and had doubled to 7.0% by 2014.