Serum Uric Acid as an Independent Predictor of Non-Alcoholic Fatty Liver Disease in Non-Obese Young Adults
Serum Uric Acid as an Independent Predictor of Non-Alcoholic Fatty Liver Disease in Non-Obese Young Adults
SOURCE: Radcliffe CVRM
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Wednesday 5th February, 2025 - Non-alcoholic fatty liver disease (NAFLD) is a global health challenge traditionally linked to obesity. However, recent research highlights its increasing prevalence among non-obese individuals, particularly young adults. A recently published prospective cohort study in Digestive Diseases and Sciences examines the relationship between serum uric acid levels and NAFLD in non-obese young adults. This study (ChiCTR-TNC-11001489) analysed 10,938 participants aged 18≤age<45 years with a body mass index (BMI) of 18.5≤BMI<25, all initially free of NAFLD. Conducted within the Kailuan Study framework in China, participants were tracked over a median follow-up of 9.95 years to assess the predictive role of serum uric acid in NAFLD development. The study aimed to determine whether serum uric acid levels contribute to NAFLD risk even within the physiological range. This is to provide clinical evidence for the screening, diagnosis, treatment, and prevention of NAFLD among non-obese young people in China.

 

The study identified a significant association between elevated serum uric acid levels and NAFLD incidence. Among participants, 4,835 (44.20%) developed NAFLD during the follow-up period. Individuals were categorized into quartiles based on serum uric acid levels, with hazard ratios (HRs) adjusted for confounding factors. Compared to the lowest serum uric acid quartile:

  • Quartile 2: HR = 1.095 (95% CI: 1.004–1.193)
  • Quartile 3: HR = 1.195 (95% CI: 1.095–1.304)
  • Quartile 4: HR = 1.409 (95% CI: 1.289–1.541)

Kaplan-Meier survival curves demonstrated a stepwise increase in NAFLD risk across serum uric acid quartiles, with cumulative incidences of 46.19%, 51.99%, 56.52%, and 65.87% for quartiles 1–4, respectively (log-rank test P < 0.001).

 

Findings confirm that serum uric acid is an independent predictor of NAFLD in non-obese individuals. The elevated risk persists even within conventional serum uric acid reference ranges, challenging current clinical cutoffs for hyperuricemia. Given these results, healthcare providers should consider serum uric acid monitoring in metabolic risk assessments, particularly in younger adults without obesity.

 

Further analyses revealed variations in NAFLD risk based on sex and metabolic status:

  • Males in quartile 4 exhibited a higher NAFLD risk (HR: 1.450, P < 0.001) compared to females (HR: 1.269, P = 0.0012).
  • People with abdominal obesity had an increased risk (HR: 1.871, P < 0.001) versus those without (HR: 1.366, P < 0.001).
  • High-sensitivity C-reactive protein (hs-CRP) levels >3 mg/L further amplified NAFLD risk in quartile 4 (HR: 1.624, P = 0.0002).

Sensitivity analyses, excluding participants with chronic kidney disease, pre-existing hyperuricemia, or short follow-up periods (<2 years), reaffirmed the robustness of these associations.

 

Given serum uric acid's potential role in metabolic disorders, further studies should explore optimal serum uric acid thresholds for NAFLD risk prediction. Longitudinal research incorporating genetic predisposition and lifestyle interventions may refine its predictive value in non-obese populations. This large-scale study identifies serum uric acid as an independent predictor of NAFLD in non-obese young adults. These findings emphasize the need for routine serum uric acid assessments to enable early intervention and prevent NAFLD progression in younger populations.

 

References:

Li Y, Ma X, Cui S, et al. Association between serum uric acid and non-alcoholic fatty liver disease in non-obese young population: a prospective cohort study. Digest Dis Sci 2024 (online ahead of print). https://doi.org/10.1007/s10620-024-08808-9; PMID: 39719467 

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