Metabolic associated fatty liver disease (MAFLD) is more prevalent than non-alcoholic fatty liver disease (NAFLD), leading to the identification of a variety of metabolically complex fatty liver diseases. The serum uric acid/creatinine ratio (SUA/Cr) is a new biomarker discovered after renal function-normalized SUA. At present, there have been few studies on the relationship between SUA/Cr and MAFLD.

To explore the correlation of SUA/Cr with MAFLD, and its predictive value for MAFLD.

We enrolled 2 288 individuals who visited the Physical examination Center of the Affiliated Hospital of Inner Mongolia Medical University in February to June 2023. Venous blood samples were collected for laboratory tests, and abdominal ultrasonography was used to examine the liver condition. Based on the results of abdominal ultrasonography and the diagnostic criteria for MAFLD, the subjects were divided into the MAFLD group (n=945) and non-MAFLD group (n=1 343). According to SUA/Cr quartiles, the subjects were divided into Q1 group (SUA/Cr≤4.13, n=574), Q2 group (4.13<SUA/Cr≤4.84, n=573), Q3 group (4.84<SUA/Cr≤5.72, n=570), Q4 group (SUA/Cr>5.72, n=571). Spearman rank correlation analysis was used to explore the correlation between SUA/Cr and clinical data. Binary Logistic regression analysis was used to gradually explore the influencing factors of MAFLD. Receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of SUA/Cr for MAFLD.

Compared to the non-MAFLD group, the MAFLD group had higher levels of male proportion, age, waist circumference (WC), BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), glycosylated hemoglobin (HbA_1c), homocysteine (Hcy), serum uric acid (SUA), serum creatinine (Scr), and SUA/Cr ratio (P<0.001). High-density lipoprotein cholesterol (HDL-C) in the MAFLD group was lower in the non-MAFLD group (P<0.001). In the Q4 group, the WC, BMI, ALT, GGT, SUA, TC and TG were higher than those in the Q1, Q2 and Q3 groups, the AST was higher than the Q1 and Q2 groups, the DBP, ALP and HbA_1c were higher than the Q1 group, the Scr, HDL-C were lower than those in the Q1, Q2 and Q3 groups, and the age was lower than those in the Q1 and Q2 groups (P<0.05). In the Q3 group, the ALT, AST, GGT, SUA, TC and TG were higher than those in the Q1 and Q2 groups, the WC and BMI were higher than those in the Q1 group, the Scr was lower than those in the Q1 and Q2 groups, and the age and HDL-C were lower than those in the Q1 group (P<0.05). In the Q2 group, the WC, BMI, ALT, GGT, SUA, and TG were higher than those in the Q1 group, and the age and HDL-C were lower than those in the Q1 group (P<0.05). Multivariate Logistic regression analysis showed that elevated WC (OR=1.034, 95%CI=1.016-1.053), BMI (OR=1.340, 95%CI=1.266-1.418), GGT (OR=1.006, 95%CI=1.003-1.010), SUA (OR=1.002, 95%CI=1.000-1.003), TG (OR=1.319, 95%CI=1.181-1.474), and HbA_1c (OR=1.348, 95%CI=1.184-1.536) were risk factors for MAFLD, while elevated HDL-C (OR=0.334, 95%CI=0.205-0.543) was a protective factor for MAFLD (P<0.05). After adjusting for confounding factors, the risk of MAFLD in Q4 group was 1.734 (95%CI=1.220-2.465, P=0.002) compared with Q1 group. SUA/Cr predicted that the area under the curve (AUC) of MAFLD was 0.607 (95%CI=0.584-0.630), with an optimal threshold value of 4.538.

The level of SUA/Cr in MAFLD group is higher compared to the non-MAFLD group. As the SUA/Cr level increased, the detection rate of MAFLD also increased. The SUA/Cr is a risk factor for MAFLD. The SUA/Cr can be used as a predictor to evaluate the risk of developing MAFLD.