Association Between Serum Uric Acid and Non-Alcoholic Fatty Liver Disease: An Updated Systematic Review and Meta-Analysis

Qianjia Sun; Tingjing Zhang; Laeeqa Manji; Yashu Liu; Qing Chang; Yuhong Zhao; Yang Ding; Yang Xia

doi:10.2147/CLEP.S403314

Association Between Serum Uric Acid and Non-Alcoholic Fatty Liver Disease: An Updated Systematic Review and Meta-Analysis

Clin Epidemiol. 2023 Jun 5:15:683-693. doi: 10.2147/CLEP.S403314. eCollection 2023.

Authors

Qianjia Sun^#^{1

2}, Tingjing Zhang^#³, Laeeqa Manji⁴, Yashu Liu^{1

2}, Qing Chang^{1

2}, Yuhong Zhao^{1

2}, Yang Ding^{5

6}, Yang Xia^{1

2}

Affiliations

¹ Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China.
² Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, People's Republic of China.
³ School of Public Health, Wannan Medical College, Wuhu, People's Republic of China.
⁴ International Educational School, China Medical University, Shenyang, People's Republic of China.
⁵ Department of Infectious Diseases, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People's Republic of China.
⁶ Diagnosis and Treatment Centre for Liver Diseases of Liaoning Province, Shenyang, People's Republic of China.

^# Contributed equally.

Abstract

Objective: Recent epidemiological evidence shows that there is an association between serum uric acid (SUA) levels and nonalcoholic fatty liver disease (NAFLD). The purpose of this meta-analysis is to summarize all available evidence and assess the associations between SUA levels and NAFLD.

Methods: Using two databases, Web of Science and PubMed, observational studies were applied from the establishment of the databases to June 2022. We used a random effect model to construct the pooled odds ratio (OR) and 95% confidence interval (CI) to appraise the association between SUA levels and NAFLD. The Begg's test was conducted to appraise publication bias.

Results: A total of 50 studies were included, involving 2,079,710 participants (719,013 NAFLD patients). The prevalence and incidence rates (95% CIs) of NAFLD in the patients with hyperuricemia were 65% (57-73%) and 31% (20-41%), respectively. Compared to participants with lower levels of SUA, the pooled OR (95% CI) of NAFLD in those with higher levels of SUA was 1.88 (95% CI: 1.76-2.00). In the subgroup analyses, we found that SUA levels were positively associated with NAFLD in all subgroups, according to study design, study quality, sample size, sex, comparison, age, or country.

Conclusion: This meta-analysis shows that increased SUA levels are positively associated with NAFLD. The results suggested that reducing SUA levels can be a potential strategy for the prevention of NAFLD.

Registration number: PROSPERO-CRD42022358431.

Keywords: meta-analysis; nonalcoholic fatty liver disease; serum uric acid; updated.

Publication types

Review

Grants and funding

This study was supported by the National Natural Science Foundation of China (No. 81903302), the Young Elite Scientists Sponsorship Program by China Association for Science and Technology (grant number YESS20200151), the 345 Talent Project of Shengjing Hospital of China Medical University (grant number M0294), and the Scientific Research Project of Liaoning Province Education Department (grant number LJKMZ20221149 to Yang Xia).