Abstract
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a prevalent chronic liver condition strongly linked with metabolic syndrome components. The serum uric acid to creatinine (SUA/Cr) ratio has recently emerged as a potential biomarker of metabolic dysfunction. However, its clinical relevance in individuals with NAFLD remains underexplored. The objectives of the current research was to investigate the association between the SUA/Cr ratio and metabolic risk factors in adults diagnosed with NAFLD. METHODS: This cross-sectional study included 226 adults with ultrasonography-confirmed NAFLD (grades 1 and 2). Participants were categorized into tertiles based on their SUA/Cr ratio. Anthropometric indices, biochemical parameters (lipid profile, liver enzymes, glucose), and lifestyle factors were assessed. Differences across SUA/Cr tertiles were analyzed using ANOVA and general linear models adjusted for confounders. RESULTS: Higher SUA/Cr tertiles were associated with significantly elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels (p = 0.011 and p < 0.001, respectively), and higher alanine aminotransferase (ALT) (p = 0.010), indicating hepatic injury. Central obesity indices (waist circumference and waist-to-hip ratio) increased significantly across tertiles (p = 0.023 and p = 0.025, respectively), although BMI did not. SUA/Cr was not significantly associated with fasting blood glucose or triglycerides. These findings suggest a strong association between elevated SUA/Cr and an unfavorable metabolic and hepatic profile in NAFLD patients. CONCLUSION: The SUA/Cr ratio is a simple, non-invasive biomarker associated with dyslipidemia, liver enzyme elevation, and central obesity in NAFLD individuals. It may serve as a practical tool for early risk stratification and metabolic monitoring in this high-risk population. Further longitudinal studies are warranted to validate its role in NAFLD progression. CLINICAL TRIAL NUMBER: Not applicable.