Figure 1
Study flow diagram. HbsAg, surface antigen hepatitis B virus; HCV, hepatitis C virus; NAFLD, non-alcoholic fatty liver disease.
Table 1
Baseline characteristics, demographic data, and hyperuricemia and metabolic disease prevalence of patients according to presence of NAFLD
| Health check-up patients (N = 1,343) | Normal patients n = 596 (44.4) | Patients with NAFLD n = 747 (55.6) | Hepatic steatosis status | P† | P for trend | ||
|---|---|---|---|---|---|---|---|
| Mild FL n = 435 (32.4) | Moderate FL n = 248 (18.5) | Severe FL n = 64 (4.7) | |||||
| Age (years) | 44.1 (13.0) | 48.9 (10.7) | 48.7 (11.2) | 49.5 (10.0) | 46.8 (10.0) | <0.001 | <0.001 |
| Male sex, n (%) | 265 (44.5) | 509 (68.1) | 261 (60.0) | 196 (79.0) | 52 (81.3) | <0.001 | <0.001 |
| Normal weight (BMI <23) | 425 (71.3) | 183 (24.5) | 151 (34.7) | 30 (12.1) | 2 (3.1) | ||
| Overweight (BMI ≥23, <25) | 119 (20.0) | 236 (31.6) | 155 (35.6) | 75 (30.2) | 6 (9.4) | <0.001 | <0.001 |
| Obese (BMI ≥25) | 52 (8.7) | 328 (43.9) | 129 (29.7) | 143 (57.7) | 56 (87.5) | ||
| Body weight (kg) | 59 (10) | 70 (11) | 66 (10) | 73 (10) | 82 (13) | <0.001 | <0.001 |
| Height (cm) | 165 (8) | 167 (8) | 166 (8) | 168 (7) | 170 (9) | <0.001 | <0.001 |
| SBP (mmHg) | 115 (15) | 123 (17) | 120 (16) | 126 (16) | 132 (20) | <0.001 | <0.001 |
| WC (cm) | 73 (7) | 82 (8) | 79 (7) | 85 (6) | 93 (9) | <0.001 | <0.001 |
| Platelet count (×104/mL) | 240 (47) | 244 (51) | 243 (52) | 244 (50) | 250 (51) | 0.17 | 0.38 |
| Fasting glucose (mg/dL) | 91 (9) | 101 (17) | 98 (14) | 103 (17) | 112 (26) | <0.001 | <0.001 |
| Triglyceride (mg/dL) | 85 (39) | 144 (97) | 118 (66) | 174 (120) | 203 (119) | <0.001 | <0.001 |
| AST (IU/L) | 24 (9) | 27 (13) | 25 (11) | 30 (13) | 38 (18) | <0.001 | <0.001 |
| ALT (IU/L) | 19 (9) | 29 (23) | 22 (15) | 35 (27) | 54 (28) | <0.001 | <0.001 |
| Total cholesterol (mg/dL) | 190 (33) | 199 (37) | 196 (35) | 203 (38) | 206 (38) | <0.001 | <0.001 |
| HDL cholesterol (mg/dL) | 60 (12) | 52 (10) | 54 (10) | 49 (9) | 47 (8) | <0.001 | <0.001 |
| LDL cholesterol (mg/dL) | 111 (24) | 122 (27) | 118 (26) | 126 (29) | 128 (29) | <0.001 | <0.001 |
| SUA (mg/dL) | 5.03 (1.29) | 5.75 (1.38) | 5.46 (1.32) | 6.09 (1.32) | 6.43 (1.51) | <0.001 | <0.001 |
| NFS | –2.44 (1.12) | –2.00 (1.15) | –2.01 (1.14) | –2.01 (1.17) | –1.86 (1.17) | <0.001 | <0.001 |
| Prevalence of hyperuricemia and metabolic disease n (%) | |||||||
| Hyperuricemia (19.1) | 76 (12.8) | 181 (24.2) | 71 (16.3) | 80 (32.3) | 30 (46.9) | <0.001 | <0.001 |
| HTN (22.9) | 72 (12.1) | 235 (31.5) | 113 (26.0) | 90 (36.3) | 32 (50.0) | <0.001 | <0.001 |
| Low LDL or statin medication(24.3) | 93 (15.6) | 234 (31.3) | 114 (26.2) | 99 (39.9) | 21 (32.8) | <0.001 | <0.001 |
| DM (6.4) | 15 (2.5) | 71 (9.5) | 25 (5.7) | 33 (13.3) | 13 (20.3) | <0.001 | <0.001 |
Data are presented as mean (SD) or number (percent).
† Between normal patients and patients with NAFLD. A Student t test or ANOVA were used for continuous variables. χ2 test was used for categorical variables.
ALT, alanine aminotransferase; ANOVA, analysis of variance; AST, aspartate aminotransferase; BMI, body mass index; MetS, metabolic syndrome; DBP, diastolic blood pressure; DM, diabetic mellitus; HDL, high density lipoprotein; HTN, hypertension; LDL, low-density lipoprotein; NAFLD, non-alcoholic fatty liver disease; NFS, NAFLD fibrosis score; SBP, systolic blood pressure; SUA, serum uric acid; WC, waist circumference.
Table 2
Prevalence of hyperuricemia according to underlying disease
| Underlying disease condition | Prevalence of hyperuricemia | P |
|---|---|---|
| NAFLD (−) | 76 (12.8) | <0.001 |
| NAFLD (+) | 181 (24.2) | |
| ALT abnormality (−) | 200 (17) | <0.001 |
| ALT abnormality (+) | 57 (34.5) | |
| HTN (−) | 176 (17) | <0.001 |
| HTN (+) | 81 (26.4) | |
| Liver fibrosis (NFS grade £ 1) | 254 (19.1) | 0.82 |
| Liver fibrosis (NFS grade =2) | 3 (21.4) | |
| Diabetes mellitus (−) | 243 (19.3) | 0.49 |
| Diabetes mellitus (+) | 14 (16.3) |
[i] Data are presented as number (percent). χ2 test was used to calculate P. ALT, alanine aminotransferase; HTN, hypertension; NAFLD, non-alcoholic fatty liver disease; NFS, NAFLD fibrosis score.
Figure 2
Scatter plots for SUA level versus FLI (A), ALT (B), and NFS (C). Histograms of SUA level versus presence of NAFLD (D), abnormal ALT (E), and NFS grade (F). Histogram bars indicate means, error bars indicate standard deviation from the mean. Pearson correlation coefficients and P-values are presented in the scatter plots. Abnormal ALT is defined as a serum ALT level ≥ 40 IU/L. A Student t test (D, E), or ANOVA (F) was used to compare each group. NFS grade 0, advanced fibrosis was excluded; 1, needs further examination; and 2 indicates suspected advanced fibrosis. ALT, serum alanine transferase level (IU/L); ANOVA, analysis of variance; NAFLD, non-alcoholic fatty liver disease; NFS, NAFLD fibrosis score; Uric acid, serum uric acid level.
Table 3
Multivariate risk factor analysis for patients with elevated NFS grade by logistic regression
| Variable | NFS grade | Odds ratio | Confidence interval | P | |
|---|---|---|---|---|---|
| 0 (n = 1,051) | ≥1 (n = 292) | ||||
| Age (year) | 44.7 (12) | 54.3 (8.9) | 1.08 | 1.06–1.09 | <0.001 |
| Male sex | 572 (54.4) | 202 (69.2) | 1.59 | 1.15–2.20 | 0.005 |
| BMI (kg/m2) | 22.9 (3.1) | 25.2 (3.2) | 1.27 | 1.20–1.34 | <0.001 |
| HTN | 205 (19.5) | 102 (34.9) | 0.73 | 0.51–1.04 | 0.085 |
| Diabetes mellitus | 36 (3.4) | 50 (17.1) | 2.82 | 1.70–4.69 | <0.001 |
| NAFLD | 538 (51.2) | 209 (71.6) | 0.97 | 0.68–1.39 | 0.88 |
| Abnormal ALT | 115 (10.9) | 50 (17.1) | 0.68 | 0.43–1.05 | 0.082 |
| Hyperuricemia | 198 (18.8) | 59 (20.2) | 0.94 | 0.65–1.37 | 0.75 |
[i] Data are presented as mean (SD) or number (percent).
[ii] ALT, alanine aminotransferase; BMI, body mass index; HTN, hypertension; NAFLD, non-alcoholic fatty liver disease; NFS, NAFLD fibrosis score.