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Hyperuricemia Ups Risk for Non-Alcoholic Fatty Liver Disease

Patients with hyperuricemia are at increased risk for non-alcoholic fatty liver disease (NAFLD), a new study finds.

Investigators performed an updated systematic review and meta-analysis of 50 studies published 2009-2022 involving 2,079,710 patients, including 719,013 with NAFLD. NAFLD was prevalent in 65% of patients with hyperuricemia, variably defined, and newly developed in 31%, Yang Xia, PhD, of Shengjing Hospital of China Medical University Shenyang, Liaoning, China, and colleagues reported in Clinical Epidemiology. The odds for NAFLD significantly increased 2.1-fold in patients with elevated vs normal serum uric acid levels.

Women with hyperuricemia had a higher probability of NAFLD than men: 2.1- vs 1.8-fold higher odds. The odds of NAFLD increased with age: 1.8-, 2.0-, and 3.4-fold in adults aged 44 or younger, 45-59 years, and 60 years or older, respectively. Patients with gout had 1.4-fold increased odds of NAFLD, compared with those without gout.

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Among possible mechanisms, serum uric acid may promote liver fat synthesis and accumulation through mitochondrial oxidative stress, Dr Xia’s team suggested. It’s also possible that NAFLD increases expression and activity of xanthine oxidase, thus spurring serum uric production.

The investigators strictly defined NAFLD as liver steatosis exceeding 5% assessed via imaging or histology with recent alcohol consumption or other liver diseases. They distinguished NAFLD from the newly coined condition metabolic dysfunction-associated fatty liver disease (MAFLD), characterized by overweight/obesity, type 2 diabetes, or metabolic disorder. NAFLD may lead to advanced liver diseases such as fibrosis, cirrhosis, and liver cancer.


Sun Q, Zhang T, Manji L, et al. Association between serum uric acid and non-alcoholic fatty liver disease: An updated systematic review and meta-analysis. Clin Epidemiol. 2023; 15: 683-693. Published online June 5, 2023. doi:10.2147/CLEP.S403314