1
|
Sun Q, Zhang T, Manji L, Liu Y, Chang Q, Zhao Y, Ding Y, Xia Y. Association Between Serum Uric Acid and Non-Alcoholic Fatty Liver Disease: An Updated Systematic Review and Meta-Analysis. Clin Epidemiol 2023; 15:683-693. [PMID: 37305378 PMCID: PMC10252946 DOI: 10.2147/clep.s403314] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/24/2023] [Indexed: 06/13/2023] Open
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.
Collapse
Affiliation(s)
- Qianjia Sun
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People’s Republic of China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, People’s Republic of China
| | - Tingjing Zhang
- School of Public Health, Wannan Medical College, Wuhu, People’s Republic of China
| | - Laeeqa Manji
- International Educational School, China Medical University, Shenyang, People’s Republic of China
| | - Yashu Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People’s Republic of China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, People’s Republic of China
| | - Qing Chang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People’s Republic of China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, People’s Republic of China
| | - Yuhong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People’s Republic of China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, People’s Republic of China
| | - Yang Ding
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People’s Republic of China
- Diagnosis and Treatment Centre for Liver Diseases of Liaoning Province, Shenyang, People’s Republic of China
| | - Yang Xia
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, China Medical University, Shenyang, People’s Republic of China
- Key Laboratory of Precision Medical Research on Major Chronic Disease, Shenyang, People’s Republic of China
| |
Collapse
|
2
|
Culafic M, Vezmar Kovacevic S, Dopsaj V, Stulic M, Vlaisavljevic Z, Miljkovic B, Culafic D. A Simple Index for Nonalcoholic Steatohepatitis-HUFA-Based on Routinely Performed Blood Tests. ACTA ACUST UNITED AC 2019; 55:medicina55060243. [PMID: 31163711 PMCID: PMC6631799 DOI: 10.3390/medicina55060243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 02/06/2023]
Abstract
Background and objectives: Data suggests that nearly 30% of the general population have steatosis and up to 5% of this population develops nonalcoholic steatohepatitis (NASH). Liver biopsy is still considered to be the gold standard for the diagnosis of NASH. Great effort is being made toward the identification of sensitive diagnostic tests that do not involve invasive procedures to address a common concern in patients with the nonalcoholic fatty liver disease—whether they have NASH or simple steatosis. We aimed to investigate the independent predictors and develop a non-invasive, easy-to-perform, low-cost set of parameters that may be used in clinical practice to differentiate simple steatosis from NASH. Methods: А cross-sectional study of nonalcoholic fatty liver disease (NAFLD) patients divided into two groups: group I—simple steatosis (SS) and group II—biopsy-proven NASH. Strict inclusion criteria and stepwise analysis allowed the evaluation of a vast number of measured/estimated parameters. Results: One hundred and eleven patients were included—82 with simple steatosis and 29 with biopsy-proven NASH. The probability of NASH was the highest when homeostatic model assessment of insulin resistance (HOMA-IR) was above 2.5, uric acid above 380 µmol/L, ferritin above 100 µg/L and ALT above 45 U/L. An acronym of using first letters was created and named the HUFA index. This combined model resulted in an area under the receiver operator characteristic curve (AUROC) of 0.94, provided sensitivity, specificity, positive predictive value and a negative predictive value for NASH of 70.3%, 95.1%, 83.1% and 90.0%, respectively. Conclusion: We suggest a simple non-invasive predictive index HUFA that encompasses four easily available parameters (HOMA-IR, uric acid, ferritin and ALT) to identify patients with NASH, which may reduce the need for a liver biopsy on a routine basis in patients with NAFLD.
Collapse
Affiliation(s)
- Milica Culafic
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia.
- Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Sandra Vezmar Kovacevic
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia.
| | - Violeta Dopsaj
- Department of Medical Biochemistry, Clinical Centre of Serbia, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia.
| | - Milos Stulic
- Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Zeljko Vlaisavljevic
- Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Branislava Miljkovic
- Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia.
| | - Djordje Culafic
- Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| |
Collapse
|
3
|
Yang C, Yang S, Feng C, Zhang C, Xu W, Zhang L, Yan Y, Deng J, Ohore OE, Li J. Associations of hyperuricemia and obesity with remission of nonalcoholic fatty liver disease among Chinese men: A retrospective cohort study. PLoS One 2018; 13:e0192396. [PMID: 29415050 PMCID: PMC5802898 DOI: 10.1371/journal.pone.0192396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/23/2018] [Indexed: 12/11/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common chronic disease that is associated with high serum uric acid (SUA) levels, although the effects of high SUA levels on NAFLD remission remain unclear. In addition, it is unclear whether obesity and high SUA levels have a combined effect on NAFLD remission. This retrospective cohort study evaluated male employees of seven Chinese companies and investigated the association between high SUA levels and NAFLD remission, as well as the potential combined effect of high SUA levels and obesity on NAFLD remission. The study followed 826 men with NAFLD for 4 years, and the NAFLD remission rate was 23.2% (192/826). Comparing to obese and non-obese individuals with normouricemia, individuals with hyperuricemia had significant higher values for total cholesterol, triglycerides, creatinine, and aspartate transaminase (all P < 0.05). Among non-obese individuals, hyperuricemia was associated with a lower NAFLD remission rate, compared to normouricemia (P < 0.001). However, no significant difference was observed between hyperuricemia and normouricemia among obese subjects (P > 0.05). Similar results were observed in the multivariate cox proportional hazard regression analyses. Compared to the normouricemia subjects, individuals with hyperuricemia had a significant lower likelihood of NAFLD remission (RR = 0.535, 95% CI: 0.312-0.916); and obese subjects had a significant lower likelihood of NAFLD remission than the non-obese individuals (RR = 0.635, 95% CI: 0.439-0.918). In addition, the interaction between hyperuricemia and obesity had a statistically significant effect on NAFLD remission (P = 0.048). In conclusion, hyperuricemia and obesity may be involved in NAFLD development and remission, with similar pathogenic mechanisms. Further studies are needed to confirm our findings and determine how to improve these individuals' conditions.
Collapse
Affiliation(s)
- Chao Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southwest Medical University, Luzhou, China
| | - Shujuan Yang
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu, China
| | - Chunhong Feng
- Health Management Department, the First Affiliated Hospital, College of Medicine, Southwest Medical University, Luzhou, China
| | - Chuan Zhang
- Department of Palliative Medicine, No. 4 West China Teaching Hospital, Sichuan University, Chengdu, China
| | - Weiwei Xu
- Health Management Department, the First Affiliated Hospital, College of Medicine, Southwest Medical University, Luzhou, China
| | - Liyun Zhang
- Health Management Department, the First Affiliated Hospital, College of Medicine, Southwest Medical University, Luzhou, China
| | - Yixin Yan
- Health Management Department, the First Affiliated Hospital, College of Medicine, Southwest Medical University, Luzhou, China
| | - Jiaqi Deng
- Department of Ultrasonography, the First Affiliated Hospital, College of Medicine, Southwest Medical University, Luzhou, China
| | | | - Jing Li
- Department of Educational affairs, Southwest Medical University, Luzhou, China
- * E-mail:
| |
Collapse
|
4
|
Wijarnpreecha K, Panjawatanan P, Lekuthai N, Thongprayoon C, Cheungpasitporn W, Ungprasert P. Hyperuricaemia and risk of nonalcoholic fatty liver disease: A meta-analysis. Liver Int 2017; 37:906-918. [PMID: 27891768 DOI: 10.1111/liv.13329] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 11/23/2016] [Indexed: 02/13/2023]
Abstract
BACKGROUND The association between hyperuricaemia and nonalcoholic fatty liver disease (NAFLD), one of the leading causes of cirrhosis worldwide, has been demonstrated in recent epidemiological studies. This meta-analysis was conducted to summarize all available data and to estimate the risk of NAFLD among subjects with hyperuricaemia. METHODS Comprehensive literature review was conducted using MEDLINE and EMBASE database through August 2016 to identify studies that compared the risk of NAFLD among subjects with hyperuricaemia vs those with normal uric acid level. Effect estimates from individual study were extracted and combined together using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS Twenty-five studies met the eligibility criteria and were included in the meta-analysis. The risk of NAFLD in subjects with hyperuricaemia was significantly higher than subjects with normal uric acid level with the pooled odds ratio (OR) of 1.97 (95% confidence interval (CI), 1.69-2.29). The heterogeneity between studies of the overall analysis was high with an I2 of 87%. Subgroup analysis based on 11 studies that provided data on males subgroup and nine studies that provided data on females subgroup showed that the risk was significantly increased for both sexes with pooled OR of 1.64 (95% CI, 1.40-1.93) among males and pooled OR of 2.21 (95% CI, 1.85-2.64) among females. CONCLUSIONS A significantly increased risk of NAFLD among patients with hyperuricaemia was demonstrated in this meta-analysis. Further studies are required to establish the role of uric acid in the pathogenesis of NAFLD.
Collapse
Affiliation(s)
- Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | | | - Natasorn Lekuthai
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | | | - Patompong Ungprasert
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
5
|
Yang C, Yang S, Xu W, Zhang J, Fu W, Feng C. Association between the hyperuricemia and nonalcoholic fatty liver disease risk in a Chinese population: A retrospective cohort study. PLoS One 2017; 12:e0177249. [PMID: 28510581 PMCID: PMC5433681 DOI: 10.1371/journal.pone.0177249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common chronic disease associated with high levels of serum uric acid (SUA). However, whether this relationship applies in obese subjects has been unclear, and no cohort study has previously been conducted in non-obese subjects. We therefore performed a retrospective cohort study among employees of seven companies in China to investigate whether hyperuricemia was independently associated with NAFLD in obese and non-obese subjects, respectively. A total of 2383 initially NAFLD-free subjects were followed up for four years, and 15.2% (363/2383) developed NAFLD. Hyperuricemia subjects had a higher cumulative incidence than did those with normouricemia (29.0% vs. 12.9%, P<0.001). Cox proportional hazard regression analyses showed that baseline hyperuricemia was significantly associated with risk of developing NAFLD in non-obese subjects. This relationship was significantly independent of baseline age, gender, metabolic syndrome components, and other clinical variables (RR = 1.389, 95%CI: 1.051-2.099). However, this association did not exist in obese subjects (RR = 1.010, 95%CI: 0.649-1.571). The independent effect of hyperuricemia on NAFLD was stronger in females (RR = 2.138, 95%CI: 1.050-4.355) than in males (RR = 1.435, 95%CI: 1.021-2.018). In conclusion, further studies are needed to explore the different mechanisms between obese and non-obese subjects, and the reason hyperuricemia raises NAFLD risk in females more than in males.
Collapse
Affiliation(s)
- Chao Yang
- Department of Epidemiology and Health statistics, School of Public Health, Southwest medical University, Luzhou, China
| | - Shujuan Yang
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu, China
| | - Weiwei Xu
- Health Management Department, the First Affiliated Hospital, College of Medicine, Southwest Medical University, Luzhou, China
| | - Junhui Zhang
- Department of Epidemiology and Health statistics, School of Public Health, Southwest medical University, Luzhou, China
| | - Wenguang Fu
- Department of Hepatobiliary Surgery the First Affiliated Hospital, College of Medicine, Southwest Medical University, Luzhou, China
| | - Chunhong Feng
- Health Management Department, the First Affiliated Hospital, College of Medicine, Southwest Medical University, Luzhou, China
| |
Collapse
|
6
|
Ethnicity matters: A Systematic Review and Meta-Analysis of the Non-Linear Relationship Between Alcohol Consumption and Prevalence and Incidence of Hepatic Steatosis. EBioMedicine 2016; 8:317-330. [PMID: 27428441 PMCID: PMC4919723 DOI: 10.1016/j.ebiom.2016.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fatty liver (hepatic steatosis) is one of the most common diseases globally, with increasing prevalence. The role of alcohol consumption in the development of hepatic steatosis has not been systematically examined. METHODS We searched Medline, Embase, and ProQuest Dissertations & Theses Global for original data on the relationship between alcohol consumption and hepatic steatosis measured by non-invasive imagery, excluding studies conducted in participants <18years, or subgroups related to viral and drug-induced liver disease. We identified 18 articles reporting adjusted data (Japan=11, other high-income countries=7). Random-effect categorical meta-analyses (<20g/day pure alcohol consumption vs non-drinkers) and dose-response meta-analyses for the whole range of alcohol consumption were conducted. RESULTS In total, 99,370 participants and 25,662 cases of hepatic steatosis were included. In Japan, low alcohol consumption was consistently associated with substantially reduced incidence and prevalence of hepatic steatosis compared to non-drinkers (RR for <20g pure alcohol/day=0.75, 95% CI: 0.71-0.79, I(2)=0%). No overall association was found in other countries (RR=1.05, 95% CI: 0.86-1.30, I(2)=84%). Dose-response analyses in Japan (up to 80g/day) showed an inverse relationship in men and a J-shape in women. CONCLUSIONS Alcohol consumption showed a complex association with hepatic steatosis with substantial differences by ethnicity and sex. Low alcohol consumption was beneficial in Japan with good epidemiological evidence, whereas there was no association in other countries. However, heterogeneity was large in countries other than Japan. More and higher quality research in diverse ethnic populations is needed to further clarify this relationship.
Collapse
|
7
|
Xu C. Hyperuricemia and nonalcoholic fatty liver disease: from bedside to bench and back. Hepatol Int 2015; 10:286-93. [DOI: 10.1007/s12072-015-9682-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/22/2015] [Indexed: 12/26/2022]
|
8
|
Sun DQ, Wu SJ, Liu WY, Lu QD, Zhu GQ, Shi KQ, Braddock M, Song D, Zheng MH. Serum uric acid: a new therapeutic target for nonalcoholic fatty liver disease. Expert Opin Ther Targets 2015; 20:375-87. [PMID: 26419119 DOI: 10.1517/14728222.2016.1096930] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) is a major, worldwide public health problem. NAFLD is recognized as a major cause of liver-related morbidity and mortality. However, physicians are currently limited by available treatment options. Recently, numerous studies have reported a correlation between serum uric acid (SUA) and NAFLD with numerous clinical and experimental studies demonstrating a significant correlation. This review will focus on the role of SUA in the development of NAFLD and its potential role as a new target for therapeutic intervention. AREAS COVERED This review discusses SUA as a significant independent factor in the development of NAFLD. Moreover, we introduce the causal relationship between SUA, metabolic syndrome, and NAFLD. We discuss two major theories of insulin resistance and inflammasomes as potential explanations of the mechanistic link between SUA and NAFLD. In addition, we review current and emerging therapeutic medications to control appropriate SUA levels. EXPERT OPINION There is an urgent need to develop novel, safe and effective therapies for the growing NAFLD epidemic. Reduction of SUA may be a promising potential treatment for patients with NAFLD. Clinical studies are required to determine the therapeutic effect of attenuation of hyperuricemia in humans with NAFLD.
Collapse
Affiliation(s)
- Dan-Qin Sun
- a 1 Nanjing Medical University, Affiliated Wuxi Second Hospital, Department of Nephrology , Wuxi 214002, China
| | - Sheng-Jie Wu
- b 2 The First Affiliated Hospital of Wenzhou Medical University, the Heart Center, Department of Cardiovascular Medicine , Wenzhou 325000, China
| | - Wen-Yue Liu
- c 3 The First Affiliated Hospital of Wenzhou Medical University, Department of Endocrinology , Wenzhou 325000, China
| | - Qian-Di Lu
- a 1 Nanjing Medical University, Affiliated Wuxi Second Hospital, Department of Nephrology , Wuxi 214002, China
| | - Gui-Qi Zhu
- d 4 The First Affiliated Hospital of Wenzhou Medical University, Liver Research Center, Department of Infection and Liver Diseases , Wenzhou 325000, China and .,e 5 Wenzhou Medical University, School of the First Clinical Medical Sciences , Wenzhou 325000, China
| | - Ke-Qing Shi
- d 4 The First Affiliated Hospital of Wenzhou Medical University, Liver Research Center, Department of Infection and Liver Diseases , Wenzhou 325000, China and .,f 6 Wenzhou Medical University, Institute of Hepatology , Wenzhou 325000, China
| | - Martin Braddock
- g 7 Global Medicines Development, AstraZeneca R&D , Alderley Park, UK
| | - Dan Song
- a 1 Nanjing Medical University, Affiliated Wuxi Second Hospital, Department of Nephrology , Wuxi 214002, China
| | - Ming-Hua Zheng
- d 4 The First Affiliated Hospital of Wenzhou Medical University, Liver Research Center, Department of Infection and Liver Diseases , Wenzhou 325000, China and .,f 6 Wenzhou Medical University, Institute of Hepatology , Wenzhou 325000, China
| |
Collapse
|
9
|
Uyanik M, Sertoglu E, Kayadibi H. Patient selection bias may derive from the improper usage of diagnostic methods. Climacteric 2014; 17:720. [PMID: 25399701 DOI: 10.3109/13697137.2014.974534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Metin Uyanik
- Corlu Military Hospital, Biochemistry Laboratory , Tekirdag
| | | | | |
Collapse
|