Original articleRelationship between uric acid and hepatic steatosis among KoreansRelation entre hyperuricémie et stéatose hépatique chez les coréens
Introduction
It is well known that hepatic steatosis is an additional feature of insulin resistance. The evidence also suggests that hepatic steatosis is predictive of coronary heart disease (CHD) risk [1], [2]. Epidemiological studies have found that uric acid may be an independent risk factor for CHD [3], [4]. Therefore, there appears to be a close relationship between hepatic steatosis and high uric-acid levels, as uric acid may play a role in insulin resistance [5]. However, the association between uric acid and hepatic steatosis remains controversial, and differs according to weight status. Most studies that have controlled for other metabolic risk factors suggest a positive relationship between serum uric acid and hepatic steatosis in obese individuals while, in non-obese individuals, uric acid is not consistently associated with the presence of hepatic steatosis [1], [6], [7]. Moreover, few studies have examined this difference in association with other metabolic abnormalities. Therefore, the objective of the present study was to clarify the relationship between high uric acid and the presence of hepatic steatosis according to body mass index (BMI) and the coexistence of the metabolic syndrome (MetS).
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Study subjects
This study used data generated from 15,791 Korean adults (8667 men and 7124 women) who visited the Center of Health Promotion at the Inje University Busan Paik Hospital between March 2005 and June 2006. Subjects with evidence of excessive alcohol intake (≥ 20 g/day) and those with positive seromarkers for hepatitis B or C, biliary disease, liver cirrhosis or malignant disease were excluded, using surveys on alcohol intake, self-reported past medical history, laboratory tests and ultrasonography.
Results
Of the 13,621 subjects, 26.2% were diagnosed with hepatic steatosis by ultrasonography. Of the total number of subjects, 11.9% of the non-obese and 52.5% of the obese individuals had hepatic steatosis. The risk of hepatic steatosis was 1.8-fold higher in men compared with women (35.0% vs 16.3%, respectively; Table 1). However, the prevalence of hepatic steatosis in women increased sharply with age regardless of BMI category, so that the gender discrepancy decreased with age (Fig. 1).
Discussion
Many studies have examined the risk factors for hepatic steatosis and found that the MetS components are strongly associated with the presence of hepatic steatosis [12], [13]. However, the relationship between elevated uric-acid levels and hepatic steatosis according to BMI category is not clear. In the present study of 13,621 Korean adults who visited a health checkup centre, there was a significant and independent relationship between increasing levels of uric acid and the presence of hepatic
Conflicts of interest
None.
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Prevalence and associated metabolic factors of fatty liver disease in the elderly
2013, Experimental GerontologyCitation Excerpt :The present study demonstrates a close relationship between high SUA and FLD in the elderly. Indeed, SUA has been found to predicate FLD independently of body weight and MS (Lee, 2009; Ryu et al., 2011). The underlying mechanism is not well studied but may depend on uric acid-induced endothelial dysfunction (Khosla et al., 2005; Ryu et al., 2011), inflammation, and oxidative stress (Sautin et al., 2007).
Association of uric acid levels with components of metabolic syndrome and non-alcoholic fatty liver disease in overweight or obese children and adolescents
2013, Jornal de PediatriaCitation Excerpt :The finding of hyperglycemia in this age group is unusual, as the more frequent manifestation of glucose metabolism is IR, which is a compensatory mechanism, while glucose tolerance remains normal.24 Although no association with hepatic steatosis was observed in this sample, recent studies have described a significant association between high levels of uric acid and NAFLD, representing an independent risk factor for liver disease.25–27 The most plausible explanation for this association, which has been inferred from the current understanding of NAFLD progression, would be the “two-hit” theory.
Relation of uric acid to serum levels of high-sensitivity c-reactive protein, triglycerides, and high-density lipoprotein cholesterol and to hepatic steatosis
2012, American Journal of CardiologyCitation Excerpt :These findings suggest that the relation between UA and early cardiometabolic risk conditions may occur before the development of obesity and metabolic syndrome. Although some studies have documented the association of UA with inflammation,5,6 insulin resistance,1 or hepatic steatosis17 adjusted for body mass index, few have explored the relation of UA with these cardiometabolic risk conditions in the presence and absence of obesity and metabolic syndrome. Previous publications have similarly found that UA was initially associated with hs-CRP in simple or multivariable regression analyses and that this association was substantially attenuated or lost significance after adjusting for body mass index.5,6
Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress: Potential role in fructose-dependent and -independent fatty liver
2012, Journal of Biological ChemistryCitation Excerpt :These findings were paralleled with significantly decreased activity of NOX4 in the mitochondria of pound mice receiving allopurinol (Fig. 8D) with concomitant higher mitochondrial aconitase activity (Fig. 8E) and lower cytoplasmic citrate release (Fig. 8F). As mentioned in the Introduction, NAFLD is strongly associated with hyperuricemia (13–22), but one potential explanation could be because many patients with hyperuricemia have obesity and metabolic syndrome. One potential way to determine whether hyperuricemia may predict NAFLD independent of obesity is to examine the hemodialysis population, as hyperuricemia is common even when obesity is absent.