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Background and Aims: Previous studies reported that serum resistin levels were remarkably changed in patients with nonalcoholic fatty liver disease (NAFLD) but the con-clusions were inconsistent. The aim of this study was to investigate accurate serum resistin levels in adult patients with NAFLD. Methods: A complete literature research was conducted in the PubMed, Embase, and Cochrane Library databases, and all the available studies up to 7 May 2020 were reviewed. The pooled standardized mean difference (SMD) values were calculated to investigate the serum re-sistin levels in patients with NAFLD and healthy controls. Results: A total of 28 studies were included to investigate the serum resistin levels in patients with NAFLD. Patients with NAFLD had higher serum resistin levels than controls (SMD=0.522, 95％ confidence interval [CI]: 0.004–1.040, I2=95.9％). Patients with nonalcoholic steatohepatitis (NASH) had lower serum resistin levels than the healthy controls (SMD=?0.44, 95％ CI: ?0.83–0.55, I2=74.5％). In addition, no significant difference of serum resistin lev-els was observed between patients with NAFL and healthy controls (SMD=?0.34, 95％ CI: ?0.91–0.23, I2=79.6％) and between patients with NAFL and NASH (SMD=0.15, 95％ CI: ?0.06–0.36, I2=0.00％). Furthermore, subgroup and sensitivity analyses suggested that heterogeneity did not affect the results of meta-analysis. Conclusions: This meta-analysis investigated the serum resistin levels in adult patients with NAFLD comprehensively. Patients with NAFLD had higher serum resistin levels and patients with NASH had lower serum resistin levels than healthy controls. Se-rum resistin could serve as a potential biomarker to predict the development risk of NAFLD.