Could serum uric acid levels be a biomarker for metabolic dysfunction-associated steatotic liver disease?
Gastroenterology and Hepatology from Bed to Bench,
Vol. 18 No. 3 (2025),
26 August 2025
https://doi.org/10.22037/ghfbb.v18i3.3033
Abstract
Aim: In this study, we investigated the relationship between serum uric acid (SUA) and metabolic dysfunction-associated steatotic liver disease (MASLD) in patients detected through abdominal ultrasound. The second aim was to determine if there were any gender differences.
Background: High SUA levels may contribute to the mechanisms underlying various metabolic disorders, including MASLD.
Methods: We conducted a retrospective study among patients older than 18 who had been admitted to a tertiary hospital's gastroenterology outpatient clinic for over two years. A total of 200 patients diagnosed with either Grade 1, 2, or 3 hepatosteatosis by ultrasound screening and 200 patients without hepatosteatosis were included in the study. Patients' demographic features, laboratory parameters, and detailed medical history were extracted from the hospital's medical records.
Results: The mean age of the 400 patients enrolled in the study was 47.92±0.78 years, and 70.25% were men. SUA (5.34 mg/dL ± 1.52 vs. 4.64 mg/dL ± 1.28, p=0.001), alanine aminotransferase (ALT) (26.55 U/L ± 23.82 vs. 19.57 U/L ± 20.81, p=0.002), aspartate aminotransferase (AST) (22.68 U/L ± 20.35 vs. 18.07 U/L ± 9.89, p=0.005), and glycosylated hemoglobin (HbA1c) (6.45% ± 1.69 vs. 5.76% ± 1.23, p=0.001) levels were higher in the MASLD group. In the MASLD group, HbA1c, AST, and ALT were significantly higher in the Grade 2-3 group than in the Grade 1 (p=0.038, p=0.038, p=0.001, respectively).
Conclusion: Elevated SUA levels are strongly linked to MASLD, particularly in males. Ease of measurement and low cost suggest that SUA could serve as a non-invasive biomarker for MASLD detection in at-risk groups.
- metabolic dysfunction associated steatotic liver disease
- nonalcoholic fatty liver disease
- serum uric acid
- steatohepatitis
- ultrasonography
How to Cite
References
Eskridge W, Cryer DR, Schattenberg JM, Gastaldelli A, Malhi H, Allen AM, et al. Metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis: the patient and physician perspective. J Clin Med 2023;12:6216.
Riazi K, Azhari H, Charette JH, Underwood FE, King JA, Afshar EE, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2022;7:851-861.
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73-84.
Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology 2023;77:1335-1347.
Long Q, Luo F, Li B, Li Z, Guo Z, Chen Z, et al. Gut microbiota and metabolic biomarkers in metabolic dysfunction-associated steatotic liver disease. Hepatol Commun 2024;8:e0310.
Abdelhameed F, Kite C, Lagojda L, Dallaway A, Chatha KK, Chaggar SS, et al. Non-invasive scores and serum biomarkers for fatty liver in the era of metabolic dysfunction-associated steatotic liver disease (MASLD): a comprehensive review from NAFLD to MAFLD and MASLD. Curr Obes Rep 2024;13:510-531.
Darmawan G, Hamijoyo L, Hasan I. Association between serum uric acid and non-alcoholic fatty liver disease: a meta-analysis. Acta Med Indones 2017;49:136–147.
Kimura Y, Tsukui D, Kono H. Uric acid in inflammation and the pathogenesis of atherosclerosis. Int J Mol Sci 2021;22:12394.
Ruggiero C, Cherubini A, Lauretani F, Bandinelli S, Maggio M, Di Iorio A, et al. Uric acid and dementia in community-dwelling older persons. Dement Geriatr Cogn Disord 2009;27:382–389.
Jeong J, Suh YJ. Association between serum uric acid and metabolic syndrome in Koreans. J Korean Med Sci 2019;34:e307.
Culafic M, Vezmar Kovacevic S, Dopsaj V, Stulic M, Vlaisavljevic Z, Miljkovic B, et al. A simple index for nonalcoholic steatohepatitis-HUFA-based on routinely performed blood tests. Medicina 2019;55:243.
Wu SJ, Zhu GQ, Ye BZ, Kong FQ, Zheng ZX, Zou H, et al. Association between sex-specific serum uric acid and non-alcoholic fatty liver disease in Chinese adults: a large population-based study. Medicine 2015;94:e802.
Zhou Y, Wei F, Fan Y. High serum uric acid and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Biochem 2016;49:636–642.
Liu PJ, Ma F, Lou HP, Zhu YN, Chen Y. Relationship between serum uric acid levels and hepatic steatosis in non-obese postmenopausal women. Climacteric 2014;17:692-699.
Chen YL, Li H, Li S, Xu Z, Tian S, Wu J, et al. Prevalence of and risk factors for metabolic associated fatty liver disease in an urban population in China: a cross-sectional comparative study. BMC Gastroenterol 2021;21:212.
Fan N, Zhang L, Xia Z, Peng L, Wang Y, Peng Y. Sex-specific association between serum uric acid and nonalcoholic fatty liver disease in type 2 diabetic patients. J Diabetes Res 2016;2016:3805372.
Wang Z, Xu M, Hu Z, Shrestha UK. Prevalence of nonalcoholic fatty liver disease and its metabolic risk factors in women of different ages and body mass index. Menopause 2015;22:667-673.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates; 1988. https://doi.org/10.4324/9780203771587
Non-alcoholic Fatty Liver Disease Study G, Lonardo A, Bellentani S, Argo CK, Ballestri S, Byrne CD, et al. Epidemiological modifiers of non-alcoholic fatty liver disease: Focus on high-risk groups. Dig Liver Dis 2015;47:997-1006.
Masroor M, Haque Z. HbA1C as a biomarker of non-alcoholic fatty liver disease: comparison with anthropometric parameters. J Clin Transl Hepatol 2021;9:15-21.
Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Hepatology 2010;52:1836-1846.
Hamad AA, Khalil AA, Connolly V, Ahmed MH. Relationship between non-alcoholic fatty liver disease and kidney function: A communication between two organs that needs further exploration. Arab J Gastroenterol 2012;13:161–165.
Novakovic T, Mekic M, Smilic L, Smilic T, Inić-Kostic B, Jovicevic L, et al. Anthropometric and biochemical characteristics of patients with nonalcoholic fatty liver diagnosed by non-invasive diagnostic methods. Med Arch 2014;68:22–26.
Tanwani BM, Jamali AA, Jamali GM, Jamali AA, Sohail MA. Non alcoholic fatty liver disease: assessment of lipid profile estimation in different grades of fatty liver on ultrasound. Open J Prev Med 2018;8:70–83.
Mansour-Ghanaei R, Mansour-Ghanaei F, Naghipour M, Joukar F. Biochemical markers and lipid profile in nonalcoholic fatty liver disease patients in the PERSIAN Guilan cohort study (PGCS), Iran. J Family Med Prim Care 2019;8:923.
Swain M, Nath P, Parida PK, Narayan J, Padhi PK, Pati GK, et al. Biochemical profile of nonalcoholic fatty liver disease patients in eastern india with histopathological correlation. Indian J Clin Biochem 2017;32:306–314.
Bano A, Chaker L, Plompen EP, Hofman A, Dehghan A, Franco OH, et al. Thyroid function and the risk of nonalcoholic fatty liver disease: the rotterdam study. J Clin Endocrinol Metab 2016;101:3204–3211.
Sinha RA, You SH, Zhou J, Siddique MM, Bay BH, Zhu X, et al. Thyroid hormone stimulates hepatic lipid catabolism via activation of autophagy. J Clin Invest 2012;122:2428–2438.
Chao G, Chen L. Study on the independent effect of thyroid hormone based on uric acid level on NAFLD. J Health Popul Nutr 2021;40:1–7.
Zhang ML, Gao YX, Wang X, Chang H, Huang GW. Serum uric acid and appropriate cutoff value for prediction of metabolic syndrome among Chinese adults. J Clin Biochem Nutr 2013;52:38–42.
Yu TY, Jee JH, Bae JC, Jin SM, Baek JH, Lee MK, et al. Serum uric acid: A strong and independent predictor of metabolic syndrome after adjusting for body composition. Metabolism 2016;65:432–440.
Lee KW, Shin D. Concurrent presence of high serum uric acid and inflammation is associated with increased incidence of type 2 diabetes mellitus in Korean adult population. Sci Rep 2022;12:11000.
Chang CC, Wu CH, Liu LK, Chou RH, Kuo CS, Huang PH, et al. Association between serum uric acid and cardiovascular risk in nonhypertensive and nondiabetic individuals: The Taiwan I-Lan Longitudinal Aging Study. Sci Rep 2018;8:5234.
Lee SY, Park W, Suh YJ, Lim MJ, Kwon SR, Lee JH, et al. Association of serum uric acid with cardiovascular disease risk scores in Koreans. Int J Environ Res Public Health 2019;16:4632.
Liu Z, Que S, Zhou L, Zheng S. Dose-response relationship of serum uric acid with metabolic syndrome and non-alcoholic fatty liver disease incidence: a meta-analysis of prospective studies. Sci Rep 2015;5:14325.
Liu C, Liu W, Zhang G, Wang Y, Jiang J, Yang Z, et al. Conjunctional relationship between serum uric acid and serum nickel with non-alcoholic fatty liver disease in men: a cross-sectional study. Int J Environ Res Public Health 2022;19:6424.
He J, Ye J, Sun Y, Feng S, Chen Y, Zhong B. The additive values of the classification of higher serum uric acid levels as a diagnostic criteria for metabolic-associated fatty liver disease. Nutrients 2022;14:3587.
Wan X, Xu C, Lin Y, Lu C, Li D, Sang J, et al. Uric acid regulates hepatic steatosis and insulin resistance through the NLRP3 inflammasome-dependent mechanism. J Hepatol 2016;64:925-932.
Zheng X, Gong L, Luo R, Chen H, Peng B, Ren W, et al. Serum uric acid and non-alcoholic fatty liver disease in non-obesity Chinese adults. Lipids Health Dis 2017;16:202.
Huang F, Liu A, Fang H, Geng X. Serum uric acid levels in non-alcoholic steatosis patients: a meta-analysis. Asia Pac J Clin Nutr 2017;26:334–342.
Sirota JC, McFann K, Targher G, Johnson RJ, Chonchol M, Jalal DI. Elevated serum uric acid levels are associated with non-alcoholic fatty liver disease independently of metabolic syndrome features in the United States: Liver ultrasound data from the National Health and Nutrition Examination Survey. Metabolism 2013;62:392–399.
Sun Q, Zhang T, Manji L, Liu Y, Chang Q, Zhao Y, 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.
Cardoso AS, Gonzaga NC, Medeiros CC, Carvalho DF. Association of uric acid levels with components of metabolic syndrome and non-alcoholic fatty liver disease in overweight or obese children and adolescents. J Pediatr 2013;89:412–418.
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