Insulin resistance has closer correlation with the occurrence of metabolic dysfunction associated steatotic liver disease diagnosed by liver biopsy.

Objective: To explore any correlation between serum urate (SU) level or insulin resistance (IR) and metabolic dysfunction associated steatotic liver disease (MASLD) in patients with metabolic syndrome (MS).

Methods: Data from all MASLD patients, diagnosed by liver biopsy, were enrolled and divided into MASLD alone group and MASLD with MS group. They were subdivided into hyperuricemia group and normal SU group to find correlation between SU/IR and MASLD in patients with MS and independent risk factors for MASLD.

Results: Data from 539 MASLD patients were analyzed. Body mass index (BMI) ( = 0.000), waist circumference (WC) ( = 0.004), and low-density lipoprotein (LDL) ( = 0.000) were dramatically higher in MASLD with MS group than those with MASLD alone; MASLD with MS patients had significantly more family history of diabetes ( = 0.000) and hypertension ( = 0.000) than patients with MASLD alone. Height ( = 0.000), weight ( = 0.000), BMI ( = 0.000) and WC ( = 0.001), and LDL ( = 0.007) were dramatically higher in hyperuricemia patients than those with normal SU. SU was inversely associated with age ( = 0.000) and high-density lipoprotein (HDL) ( = 0.003), and positively correlated with weight ( = 0.000), BMI ( = 0.000) and WC ( = 0.000), TG ( = 0.000), and LDL ( = 0.000). Logistic Regression analysis showed that age ( = 0.031), TG ( = 0.002), LDL ( = 0.010), HbA1c ( = 0.026), and family history of hypertension ( = 0.000) may be independent risk factors for MASLD in patient with MS.

Conclusion: Insulin resistance (IR) in MASLD patients with MS, but not higher SU levels, has closer correlation with the occurrence of MASLD in patients with family history of hypertension and diabetes having higher BMI, LDL, HbA1c.