We studied the changes of serum adiponectin and it correlations in patients with type 2 diabetes (T2D) and NAFLD related to transaminases levels. Serum adiponectin levels were significantly lower in the increased ALT group than in the normal ALT and control group. After adjusting for age, sex, and adiposity adiponectin was significantly correlated in control group with fasting insulin, and insulin resistance by homeostasis model of assessment (HOMA-IR); in the normal ALT group with HDL-cholesterol , triglycerides, fasting insulin and HOMA-IR; in the elevated transaminases group with ALT, fasting insulin and HOMA-IR. Step-wise multiple linear regression analyses demonstrated that in NAFLD with normaltransaminases, independent predictors of adiponectin was HOMA-IR, triglycerides, BMI and duration of T2D. In NAFLD with elevated transaminases, adiponectin was associated with HOMA-IR, BMI, male genderand ALT.