Higher serum uric acid to HDL-cholesterol ratio is associated with onset of non-alcoholic fatty liver disease in a non-obese Chinese population with normal blood lipid levels

Abstract

Background Recent studies have demonstrated the presence of associations between metabolic syndrome and the onset of nonalcoholic fatty liver disease (NAFLD). Metabolic syndrome, in turn, has been found to be linked to high serum uric acid to HDL-cholesterol ratios (UHR). However, the relationship between UHR values and the occurrence of NAFLD in non-obese individuals remains unknown. The present study aimed to examine the possible correlation between UHR values and NAFLD onset among a non-obese Chinese population without dyslipidemia, as well as comparing the predictive value of UHR versus other NAFLD onset predictors. Methods A total of 9837 non-obese patients, with normal blood lipid levels, were included in a 5-year retrospective cohort study, and the onset of NAFLD in these patients was diagnosed by liver ultrasound. Results Out of the 9837 patients, 855 were diagnosed with NAFLD during the 5-year follow-up period, for an overall total prevalence of 8.7% at the end of the study period. Across quintiles 1, 2, 3, 4 and 5 of UHR (respectively, ratios of ≤ 120.88, 120.89–154.01, 154.02–189.91, 189.92–240.46, and ≥ 240.47), the prevalence of NAFLD among the patients increased from 2.4%, 5%, 7.9%, 10.3%, and 17.8%, respectively. After adjustments for age, gender, liver and kidney functional markers, as well as metabolic indicators, multivariate Cox proportional hazard regression analysis demonstrated that the hazard ratio (HR) was the highest in quintile 5, at 1.76 (1.12–2.75), and the lowest in quintile 1. The area under the curve (AUC) for UHR (0.690) was higher than that for serum uric acid (UA, 0.666) and HDL-C (0.636), suggesting the predictive ability of UHR for NAFLD onset was better than either alone. This finding was further supported by the presence of an independent association between UHR and NAFLD, even within the normal range of UA and HDL-C; the HR (95% confidence interval, CI) for NAFLD was 1.002 (1.000–1.004). Compared with other significant predictors, AUC for UHR (0.67) was similar to that of low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C, 0.68), non-high-density lipoprotein cholesterol (NHDL-C)/HDL-C (0.68) and alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratios (0.7), and was higher than that of LDL-C (0.63), remnant cholesterol (RC,0.59), and albumin (ALB)/alkaline phosphatase (ALP) ratio (0.61). The sensitivity of UHR (71%) was the highest among all indicators. In the subgroup with ALT < 40U/L, the AUC for UHR was 0.70, which was the highest among all predictors; among ALT > 40U/L, UHR was able to predict the occurrence of NAFLD (AUC = 0.61, p = 0.007), which was not the case for RC (P = 0.441), ALB/ALP (P = 0.419), and ALT/AST (P = 0.159). Conclusions UHR serve as an inexpensive and reliable predictor of NAFLD onset in non-obese Chinese people with normal blood lipid levels, allowing for identification of individuals at high risk for NAFLD.

Association between serum uric acid levels of patients with gout and their complications and examination fees: A cross‐sectional analysis

“…As indicated, high SUA levels are related to more than twice the levels of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. 6,26,27 The results of the present study indicate that as SUA increased by 1 μmol/L, the influence of developing liver diseases increased by 1.003 times, which is consistent with previous studies. Overall, the results of this study further support the significance of SUA levels in standard treatment for gout.…”

Correlation of multiple lipid and lipoprotein ratios with nonalcoholic fatty liver disease in patients with newly diagnosed type 2 diabetic mellitus: A retrospective study

“…Model2 Model3 ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase; ALP, alkaline phosphatase; Scr, serum creatinine; FBG, fasting blood-glucose; HbA1c, glycosylated hemoglobin; FINS, fasting insulin; TG/HDL-C, triglycerides to high-density lipoprotein-cholesterol ratio; TC/HDL-C, cholesterol to HDL-C ratio; FFA/HDL-C, free fatty acid to HDL-C ratio; UA/HDL-C, uric acid to HDL-C ratio; LDL-C/HDL-C, low-density lipoprotein-cholesterol to HDL-C ratio; APOB/A1, apolipoprotein B to apolipoprotein A1 ratio. Previous studies on the correlation between lipid-lipoprotein ratios and NAFLD have been reported (9,11,16,17,23). Ren et al (11) concluded that the TC/HDL-C ratio had a significant predictive value for NAFLD, and ROC analysis showed that the AUC (0.645) was greater than other serum lipids.…”

“…Ren et al (11) concluded that the TC/HDL-C ratio had a significant predictive value for NAFLD, and ROC analysis showed that the AUC (0.645) was greater than other serum lipids. In addition, Zhu et al (9) suggested that the predictive value of UA/HDL-C was significantly higher than LDL-C/HDL-C, non-HDL-C/HDL-C and ALT/AST in a non-obese population, even when UA and LDL-C levels were within the normal range. In a 5-year longitudinal cohort study of 9767 non-obese subjects with normal lipids, Cox proportional hazard regression model confirmed that high LDL-C/HDL-C ratios significantly increased the risk of NAFLD in non-obese Chinese subjects with normal lipids (16).…”

“…In addition, a large number of rural health centers or community hospitals lack ultrasound equipment and qualified ultrasonographers. Therefore, several previous studies have pinned hopes for early screening of patients with NAFLD on various serum markers (8)(9)(10)(11)(12)(13). However, to date, no serum marker has become an accepted diagnostic indicator for NAFLD.…”

“…Several current data have indicated that lipid and lipoprotein ratios are more valuable than individual lipid values in predicting the risk of T2DM or NAFLD because they can reflect the interaction between lipid components (11)(12)(13)(15)(16)(17). Among them, the ratios of TG to HDL-C (TG/HDL-C) (12,13), TC to HDL-C (TC/ HDL-C) (11), uric acid (UA) to HDL (UA/HDL-C) (9), LDL-C to HDL-C (LDL-C/HDL-C) (16) and apolipoprotein B to apolipoprotein A1 (APOB/A1) (17) have been previously reported to be associated with the risk of NAFLD in different populations. Besides, TG/HDL-C and TC/HDL-C have been described as promising parameters for the diagnosis of prediabetes and T2DM (15,18).…”