We conducted this case-control study to explore the association of serum uric acid (SUA) to HDL-cholesterol (HDL-C) ratio (UHR) with the risk of nonalcoholic fatty liver disease (NAFLD) in general Chinese adults. A total of 636 patients with NAFLD and 754 controls from affiliated hospital of Qingdao University in China between January to December 2016 were involved. NAFLD was diagnosed by ultrasonography after excluding other etiologies. The multivariable adjusted odds ratio and 95% confidence interval (CI) of NAFLD for the highest versus lowest quartile of UHR was 3.888 (2.324-6.504). In stratified analyses by sex and age, the positive associations between UHR and the risk of NAFLD were statistically significant in each subgroup. In stratified by BMI, the significant positive association was only found in the individuals with BMI≥23.9 kg/m2. Dose-response analysis indicated a linear positive correlation between UHR and NAFLD risk.