Background <p>Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disorder linked to insulin resistance, progressing from simple steatosis to more advanced stages such as non-alcoholic steatohepatitis (NASH) and cirrhosis. Inflammation plays a key role in the progression of NAFLD. Biomarkers like the Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Lymphocyte-to-Monocyte Ratio (LMR) have emerged as potential non-invasive indicators of inflammation.</p> Objective <p>This study aims to evaluate the association between blood cell count inflammatory biomarkers (SII, NLR, PLR, LMR) and NAFLD.</p> Methods <p>A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, with the protocol registered on PROSPERO (CRD42024601678). Studies were retrieved from PubMed, Google Scholar, ClinicalTrials.gov and Cochrane. Observational studies that reported on inflammatory biomarkers in NAFLD patients were included. Data extraction and quality assessment were done using the Newcastle-Ottawa Scale (NOS).</p> Results <p>The Neutrophil-to-Lymphocyte Ratio (NLR) showed a marginal increase (SMD = 0.45, 95% CI: − 0.10 to 1.00), with significant heterogeneity (I² = 99.4%) and publication bias. Platelet-to-Lymphocyte Ratio (PLR) was significantly lower in NAFLD (SMD = − 0.38, 95% CI: − 0.72 to − 0.04), with high heterogeneity (I² = 99.8%) and potential bias. Lymphocyte-to-Monocyte Ratio (LMR) and Systemic Immune-Inflammation Index (SII) showed no significant differences.</p> Conclusion <p>NLR and PLR show promise as biomarkers for NAFLD, but further large-scale studies are needed to address heterogeneity and publication bias.</p>