Association between the hyperuricemia and nonalcoholic fatty liver disease risk in a Chinese population: A retrospective cohort study

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 nonobese 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.