Objective: To evaluate the clinical value of serum creatinine-to-cystatin C ratio (CCR) as a serum marker for screening high-risk groups of NAFLD. Methods:  A total of 162 overweight or obese patients and 64 subjects with normal BMI were included in the study. Subjects were divided into three groups according to the CCR level. Spearman correlation, Logistic regression and ROC curve analysis were used to determine the clinical application value of CCR in NAFLD. Results: After grouping CCR based on tertiles, BMI, waist circumference, blood pressure, fasting blood glucose, 2 hours postprandial blood glucose (2hPG), HbA1c, fasting C-peptide, HOMA-IR, triglycerides, AST, ALT, γ-GT, HDL-C, and the prevalence of NAFLD showed significant differences among high, middle and low tertiles (P<0.05). The CCR value of NAFLD patients was significantly lower than that of subjects without NAFLD (P<0.01). CCR was negatively correlated with fasting blood glucose, HbA1c，AST, γ-GT, HOMA-IR, triglycerides, BMI, and waist circumference. After adjusting for age, gender, and glucose and lipid metabolism markers, the risk of NAFLD in the lowest and middle tertiles of CCR were 5.096 times and 2.722 times, respectively (P<0.05). ROC curve analysis showed that the area under the curve of CCR in the male group and female group were 0.865 (95% CI: 0.769-0.932) and 0.806 (95% CI: 0.733-0.866), and the cut points were 94.44 and 91.43, respectively. Conclusion: CCR is closely related to a variety of NAFLD risk factors and can be used as a simple new indicator for early screening of NAFLD.

［Key words］non-alcoholic fatty liver disease; serum creatinine-to-cystatin C ratio; relative muscle mass