Background <p>With the continuing global obesity epidemic, fatty pancreas disease (FPD) has become one of the most prevalent chronic pancreatic conditions. The objective of this study was to identify potential risk factors contributing to FPD among individuals who are overweight and obese.</p> Methods <p>This cross-sectional study enrolled a total of 205 participants (101 female, 104 male) who were overweight or obese. Data were collected from December 2019 to November 2023. Each participant underwent a comprehensive assessment, including clinical history documentation, physical evaluation, laboratory analysis, and magnetic resonance imaging (MRI). Based on a pancreatic fat fraction cut-off value of 10.4% measured through MRI, the participants were categorized into FPD and non-FPD groups. Differences between groups were analyzed based on sex and the presence or absence of FPD. A binary logistic regression model was constructed and used to identify risk factors for FPD. Subsequently, the diagnostic performance of the identified independent risk factors for diagnosing FPD was assessed using receiver operating characteristic curve analysis.</p> Results <p>Among men, no significant correlation was observed between serum uric acid (SUA) levels and FPD. However, among women, SUA levels were significantly elevated in individuals with FPD compared with those without FPD. Multivariate logistic regression analysis confirmed SUA as an independent predictor of FPD in women. The optimal SUA threshold for predicting FPD in women who were overweight and obese was 6.29&#xa0;mg/dL.</p> Conclusion <p>Elevated SUA levels are a risk factor for FPD in women who are overweight or obese. Therefore, clinicians should monitor pancreatic fat accumulation in women with SUA levels exceeding 6.29&#xa0;mg/dL.</p> Trial registration <p>Chinese Clinical Trial Registry ChiCTR1900022948; Registered 4 May 2019.</p>