〔Abstract〕 Objective To investigate the relationship among hepatic fat content(HFC), serum cystatin C(CysC) and insulin resistance in different glucose tolerance populations. Methods 242 patients were recruited from department of endocrinology, and they were divided into three groups: 141 patients with newly diagnosed T2 DM(NT2 DM), 48 pre-diabetes subjects(PDM) and 53 normal control(NC) with normal glucose tolerance. HFC was measured by Hydrogen proton magnetic resonance spectroscopy(1H-MRS), and the association among HFC, CysC and insulin resistance was analyzed. Results ① The levels of HFC and HOMA-IR orderly increased in NC, PDM and NT2 DM groups(all of P values were less than 0.012 5). Compared with NC group, both of PDM and NT2 DM groups had an elevated CysC level(all of P values were less than 0.001). ② All subjects were divided into four subgroups of Q1, Q2, Q3 and Q4 from low to high according to HFC quartile distribution. There were significant differences of CysC and HOMA-IR among the four subgroups(bothof P values were less than 0.05). Compared with Q1 group, the level of CysC and HOMA-IR were significantly increased in both Q3 and Q4 groups(all of P values were less than 0.008 3). The HOMA-IR in the Q4 group was significantly higher than that in the Q2 group(P<0.008 3). ③Mutilinear regression indicated that CysC was the predictor for HFC whileCysC and HFC were the predictors for the HOMA-IR(both of P values were less than 0.05). Conclusion There are an increase of CysC level in the stage of PDM and HFC(>11.62%), indicating that CysC may be an indicator for the prediction of HFC and HOMA-IR.