Objectives <p>To investigate the correlation between serum uric acid/creatinine ratio (SUA/Cr) and Metabolic-associated fatty liver disease (MAFLD) in children.</p> Methods <p>1387 participants aged 4–15 who underwent health examinations from 1/2020–12/2023 were included. Clinical indicators were compared and analyzed.</p> Results <p>Overweight/obese group had elevated levels compared to non-overweight/obese group in male proportion, uric acid (UA), serum uric acid/creatinine ratio (SUA/Cr), systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), gamma-glutamyltransferase(GGT), total protein(TP), albumin(ALB), globulin(GLO), and serum creatinine(SCr) (<i>p</i> &lt; 0.001, Kruskal–Wallis test). As SUA/Cr increased, UA, ALT, ALP, TP, GGT levels and the prevalence rates of overweight/obesity rose, while SCr levels fell (<i>p</i> &lt; 0.05, Jonckheere-Terpstra test), and positively related to body mass index (BMI) (<i>p</i> &lt; 0.05). The OR for overweight/obesity increased in higher SUA/Cr quartile groups, as Q3 (OR = 2.399, 95% confidence interval CI = 1.554–3.703) and Q4 (OR = 5.044, 95% CI = 3.281–7.754). The SUA/Cr exhibited an AUC of 0.828 (95% CI = 0.764–0.892, <i>p</i> &lt; 0.001) in predicting overweight/obesity and elevated ALT levels, with a specificity of 0.764 and sensitivity of 0. 805.</p> Conclusions <p>Children with overweight/obesity have higher liver enzymes, and elevated SUA/Cr levels may predict an increased incidence of overweight/obesity and hepatic injury.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>This study found a close association between serum uric acid/creatinine ratio (SUA/Cr) and risk factors for Metabolic-associated fatty liver disease (MAFLD) in children.</p> </ItemContent> <ItemContent> <p>SUA/Cr may be an indicator of risk factors for MAFLD in children.</p> </ItemContent> <ItemContent> <p>Elevated SUA/Cr levels may predict an increased incidence of overweight/obesity and hepatic injury.</p> </ItemContent> <ItemContent> <p>Providing an easily accessible non-invasive biomarker for predicting and preventing MAFLD in children.</p> </ItemContent> </UnorderedList></p>