Background: Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of insulin resistance and serum uric acid (SUA) levels seemed to be elevated during this disorder. There is a paucity of data regarding the association of SUA with NAFLD in prediabetes. In this context, the present study has been undertaken to investigate this association.

Methods: In a cross-sectional analytical design, a total of 110 prediabetic subjects [M/F; 63/47, age in ranges, 45 (25-68)] were recruited in the study and divided into non NAFLD (n = 62) and NAFLD (n = 48) group after examined with ultrasonogram. Insulin resistance (HOMA-IR) was calculated by homeostasis model assessment.

Results: NAFLD subjects had significantly higher levels of SUA compared to non NAFLD subjects (6.10 ± 1.42 vs. 5.38 ± 1.14, p = 0.004). They also had significantly higher levels of HOMA-IR (2.4 ± 1.09 vs. 1.4 ± 0.45, p < 0.001). In binary logistic regression analysis, HbA1c (OR = 3.505, p = 0.002), SUA (OR = 1.514, p = 0.023) and HOMA-IR (OR = 1.478, p = 0.029) were found to be significant determinants of NAFLD after adjusting the effects of BMI and triglyceride (TG). In multiple linear regression analysis, SUA showed significant positive association with HOMA-IR (ß = 0.355, p = 0.027) and TG (ß = 0.325, p = 0.033) after adjusting the effects of BMI and HbA1c.

Conclusions: Increased levels of serum uric acid are significantly associated with NAFLD and this association seemed to be mediated by insulin resistance among prediabetic subjects.