Frequency and Association of Hyperuricemia in Non-alcoholic fatty liver disease patients: Still a neglected combination?

Objective: To determine the frequency and association of hyperuricemia in non-alcoholic fatty liver disease patients.

Method: This retrospective study was conducted at multiple healthcare facilities including Baqai Institute of Diabetology and Endocrinology (BIDE), Fatima Hospital and Imam Clinic over a span of one year (July 2023 to June 2024).This multi-center approach allowed for a comprehensive analysis and ensured diverse participant representation. The study focused on patients over 18 years old with known cases of non-alcoholic fatty liver disease (NAFLD) visiting outpatient departments. Demographic details, co-morbidities, examination findings, and pertinent laboratory tests were systematically documented utilizing a standardized proforma. Additionally, ultrasound reports of liver scans were scrutinized to categorize NAFLD severity into mild, moderate, and severe cases.

Results: In this study of 246 NAFLD patients, severity distribution was 35% mild, 24.4% moderate, and 40.2% severe, with a mean age of 53.1 years and a female majority (52%). Significant associations were found between NAFLD severity and age, gender, blood pressure, tobacco use, diet, and obesity. Biomarker analysis revealed elevated levels in severe NAFLD cases, particularly uric acid (7.63 vs. 6.6 vs. 5.96; P<0.001) and HbA1c (6.77 vs. 6.15 vs. 5.8; P<0.001). Hyperuricemia was significantly associated with NAFLD severity (P: 0.001), with 56.6% of severe cases exhibiting hyperuricemia. Univariate logistic regression identified hypertension, diabetes, obesity, and severe NAFLD as significant factors for hyperuricemia (P: 0.0001).

Conclusion: A significant prevalence of hyperuricemia was noted among NAFLD patients, underscoring the importance of integrating uric acid assessments and appropriate management into NAFLD care protocols.