AbstractBackgroundThe association between serum uric acid (SUA) levels and non-alcoholic fatty liver disease (NAFLD) is controversial.ObjectivesWe compared the association of SUA levels with NAFLD, abnormal alanine transferase (ALT), and the degree of liver fibrosis to clarify the association of SUA levels with NAFLD.MethodsWe conducted a retrospective cross-sectional study. Adult patients who underwent a health check-up (N = 1,343) were included for analysis. Fatty liver was diagnosed by abdominal ultrasonography. The degree of liver fibrosis was determined using the NAFLD fibrosis score (NFS). Pearson correlation analysis showed a stronger correlation of SUA level with the fatty liver index (r= 0.40,P< 0.001) than the correlation with serum ALT level (r= 0.28,P< 0.001), or NFS (r= 0.018,P= 0.51). SUA levels in patients with NAFLD and an abnormal liver function test (LFT) result were significantly higher than levels in patients without NAFLD and abnormal LFT results. By contrast, there was no significant association of SUA level with NFS grade. When age, male sex, body mass index, the presence of hypertension, diabetic mellitus, and NAFLD, abnormality of ALT level, and SUA level were included in binary logistic regression to evaluate risk factors for elevated NFS grade, hyperuricemia was not significantly associated with NFS grade (OR = 0.94,P= 0.75).ConclusionPearson correlation and logistic regression together indicated SUA level is more closely associated with hepatic steatosis than abnormal liver function test or hepatic fibrosis.