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Background Metabolic-associated fatty liver disease (MAFLD) is a group of liver diseases related to metabolic stresses. Studies have shown that serum potassium is closely related to MAFLD. However, their relationship in gout patients remains unclear. Objective To investigate the relationship between serum potassium and MAFLD in gout patients, to provide a theoretical basis for the management of serum potassium in gout patients. Methods A total of 347 primary gout patients were recruited from Chu Hsien-I Memorial Hospital, Tianjin Medical University from April 2014 to March 2017. They were divided into simple gout group (n=96) , mild fatty liver group (n=136) and moderate-to-severe fatty liver group (n=115) according to the severity of fatty liver to compare baseline data, serum biochemical indices, overweight/obesity and insulin resistance indices. Spearman rank correlation was used to study the relationship between serum potassium level and the severity of fatty liver. Multivariate Logistic regression analysis was used to identify influencing factors of MAFLD in gout. Results Two hundred and fifty-one (72.3%) of the 347 gout patients had MAFLD. Spearman rank correlation analysis demonstrated that serum potassium level was negatively correlated with the severity of fatty liver, fasting blood glucose (FBG) , triglyceride (TG) , body mass index (BMI) , waist-to-hip ratio (WHR) and homeostasis model assessment of insulin resistance (HOMA-IR) (rs=-0.172, -0.118, -0.182, -0.222, -0.174, -0.197, P<0.05) . The chi-square test for linear trend showed that the severity of fatty liver declined with the increase of serum potassium level (χ2 =15.784, P=0.015) . Multivariate Logistic regression analysis showed that advanced age〔OR=0.97, 95%CI (0.95, 0.999) 〕 and high serum potassium〔OR=0.53, 95%CI (0.29, 0.97) 〕 were associated with reduced risk of developing MAFLD in overweight/obese gout patients (P<0.05) , while high TG〔OR=1.16, 95%CI (1.01, 1.34) 〕 and high WHR〔OR=1.09, 95%CI (1.04, 1.13) 〕 were associated with increased risk of developing MAFLD (P<0.05) . High FBG〔OR=1.92, 95%CI (1.12, 3.31) 〕 was associated with increased risk of developing MAFLD in gout patients with normal BMI (P<0.05) . Conclusion Maintaining higher serum potassium within the normal range may prevent the development of MAFLD in overweight/obese gout patients.