Abstract: Objective The aim of this study was to investigate the changes of serum uric acid (SUA) levels and its clinical implication in patients with nonalcoholic fatty liver disease ((NAFLD)) and type 2 diabetes mellitus (T2DM). Methods The study enrolled 316 patients with NAFLD in our hospital from June 2015 through December 2019, including 218 patients with NAFLD and T2DM, and 98 NAFLD patients without T2DM. The univariate and multivariate Logistic regression analysis was performed in patients with NAFLD to determine the independent risk factors related to T2DM occurrence. Results The proportion of male cases in patients with NAFLD and T2DM was 59.6%, significantly higher than 42.9% (P<0.05) in those without T2DM, the body mass index (BMI) was (27.2±2.9) kg/m², significantly higher than , blood HbA1c was (9.2±2.1)%, significantly higher than , blood high density lipoprotein (HDL) level was (0.9 ±0.2) mmol/l, significantly lower than , blood triglyceride (TG) level was (1.9±0.5) mmol/l, significantly higher than , the SUA was (335.8±72.6) mol/L, significantly higher than , the estimated glomerular filtration rate (eGFR) was (158.4±40.6) ml/min/1.73 m², significantly higher than , the fasting insulin (FINS) level was (5.1±2.6) MIU/L, significantly higher than , and the insulin resistance index (HOMA-IR) was (1.9±1.1), significantly higher than in NAFLD patients without T2DM; we taken gender, BMI, HbA1c, HDL, TG, SUA, eGFR, FINS and HOMA-IR as independent variables, and the multivariate Logistic regression analysis showed that the gender, HbA1c, SUA, FINS and HOMA-IR were (P<0.05)the independent risk factors, while the BMI, HDL, TG and eGFR were not (P>0.05)the independent risk factors for T2DM occurrence in patients with NAFLD; we divided SUA into three groups based on its levels from low to high as SUA-1, SUA-2 and SUA-3, and in 218 NAFLD patients with T2DM, the percentages of T2DM were 21.5%, 32.1% and 46.3%, with significant differences among them(P<0.05), and in 88 female NAFLD patients with T2DM, those were 10.2%, 28.4% and 61.4%, also significant different (P<0.05), while in 130 male patients ,those were 29.2%, 34.6% and 36.2%, not significant different (P>0.05).Conclusion Gender and SUA are independent predictors of T2DM occurrence in patients with NAFLD. The risk factors for T2DM should be found out and some measure should be taken to prevent the progress of NAFLD to severe consequences in clinical practice.

Key words: Nonalcoholic fatty liver disease, Type 2 diabetes mellitus, Serum uric acid, Logistic regression analysis, Risk factors