Background
Methods
Participants
Clinical examinations and biochemical assays
Diagnosis of NAFLD
Statistical analyses
Results
Characteristics of participants
Variables | Total population | SUA quintiles (For men) |
P
| ||||||
---|---|---|---|---|---|---|---|---|---|
Men (n = 3126) | Women (n = 4443) |
P
| Q1 (n = 603) | Q2 (n = 646) | Q3 (n = 617) | Q4 (n = 629) | Q5 (n = 631) | ||
Age (years) | 59.35 ± 9.38 | 60.19 ± 9.82 | < 0.001 | 59.29 ± 8.68 | 58.62 ± 9.38 | 58.42 ± 8.73 | 59.96 ± 9.91 | 60.47 ± 9.96 | < 0.001 |
BMI (kg/m2) | 23.86 ± 2.96 | 23.98 ± 3.21 | 0.090 | 22.80 ± 2.73 | 23.50 ± 2.84 | 24.00 ± 2.69 | 24.11 ± 3.03 | 24.85 ± 3.11 | < 0.001 |
SBP (mmHg) | 137.23 ± 19.28 | 141.75 ± 19.93 | < 0.001 | 133.88 ± 19.05 | 136.15 ± 18.69 | 137.29 ± 18.98 | 138.72 ± 19.54 | 140.00 ± 19.64 | < 0.001 |
DBP (mmHg) | 86.56 ± 11.78 | 84.25 ± 11.66 | < 0.001 | 83.91 ± 11.60 | 85.84 ± 11.58 | 86.86 ± 12.23 | 88.03 ± 12.10 | 88.10 ± 10.88 | < 0.001 |
TG (mmol/L) | 1.32 ± 1.11 | 1.32 ± 0.81 | 0.801 | 1.02 ± 0.66 | 1.13 ± 0.75 | 1.35 ± 1.06 | 1.35 ± 1.03 | 1.74 ± 1.63 | < 0.001 |
TC (mmol/L) | 4.74 ± 0.91 | 4.91 ± 0.90 | < 0.001 | 4.62 ± 0.82 | 4.62 ± 0.82 | 4.78 ± 0.88 | 4.74 ± 0.90 | 4.92 ± 1.05 | < 0.001 |
HDL-C (mmol/L) | 1.47 ± 0.43 | 1.51 ± 0.37 | < 0.001 | 1.57 ± 0.42 | 1.49 ± 0.40 | 1.45 ± 0.44 | 1.44 ± 0.46 | 1.38 ± 0.41 | < 0.001 |
LDL-C (mmol/L) | 2.61 ± 0.69 | 2.75 ± 0.70 | < 0.001 | 2.51 ± 0.63 | 2.54 ± 0.65 | 2.66 ± 0.68 | 2.61 ± 0.70 | 2.72 ± 0.76 | < 0.001 |
AST (U/L) | 24.52 ± 10.99 | 23.09 ± 9.50 | < 0.001 | 22.07 ± 7.16 | 23.62 ± 9.53 | 24.94 ± 10.75 | 24.84 ± 9.97 | 27.04 ± 15.23 | < 0.001 |
ALT (U/L) | 23.02 ± 15.68 | 19.99 ± 14.35 | < 0.001 | 18.77 ± 9.76 | 21.24 ± 12.05 | 24.03 ± 16.14 | 24.39 ± 17.53 | 26.55 ± 19.58 | < 0.001 |
FPG (mmol/L) | 6.07 ± 1.32 | 6.01 ± 1.21 | 0.036 | 6.19 ± 1.76 | 6.04 ± 1.34 | 6.05 ± 1.24 | 6.01 ± 1.13 | 6.06 ± 1.01 | 0.140 |
SUA (μmol/L) | 343.37 ± 77.58 | 270.46 ± 70.93 | < 0.001 | 243.31 ± 27.53 | 298.70 ± 11.49 | 336.34 ± 10.45 | 376.99 ± 13.37 | 458.10 ± 52.17 | < 0.001 |
Hyper-ALT, n (%) | 256 (8.2) | 240 (5.4) | < 0.001 | 23 (3.8) | 33 (5.1) | 64 (10.4) | 58 (9.2) | 78 (12.4) | < 0.001 |
NAFLD, n (%) | 967 (30.93) | 1262 (28.40) | 0.017 | 98 (16.3) | 147 (22.8) | 197 (31.9) | 221 (35.1) | 304 (48.2) | < 0.001 |
Mild-steatosis, n (%) | 383 (12.25) | 386 (8.69) | < 0.001 | 43 (7.1) | 77 (11.9) | 80 (13.0) | 88 (14.0) | 95 (15.1) | < 0.001 |
Severe-steatosis, n (%) | 584 (18.68) | 876 (19.72) | < 0.001 | 55 (9.1) | 70 (10.8) | 117 (19.0) | 133 (21.1) | 209 (33.1) | < 0.001 |
Characteristics of men and women according to the quintiles of SUA levels
Variables | Quintiles of SUA levels (mean ± SD) |
P
| ||||
---|---|---|---|---|---|---|
Q1 (n = 873) | Q2 (n = 881) | Q3 (n = 910) | Q4 (n = 878) | Q5 (n = 901) | ||
Age (years) | 57.50 ± 9.23 | 58.63 ± 9.36 | 59.65 ± 9.17 | 61.23 ± 9.61 | 63.87 ± 10.41 | < 0.001 |
BMI (kg/m2) | 22.51 ± 2.73 | 23.37 ± 3.09 | 23.99 ± 2.88 | 24.69 ± 3.07 | 25.33 ± 3.44 | < 0.001 |
SBP (mmHg) | 136.01 ± 18.39 | 138.10 ± 19.70 | 141.96 ± 19.27 | 144.01 ± 19.41 | 148.44 ± 20.39 | < 0.001 |
DBP (mmHg) | 81.52 ± 11.77 | 82.53 ± 11.64 | 84.29 ± 10.56 | 85.73 ± 11.60 | 87.08 ± 11.85 | < 0.001 |
TG (mmol/L) | 1.06 ± 0.734 | 1.15 ± 0.63 | 1.29 ± 0.78 | 1.44 ± 0.76 | 1.68 ± 0.96 | < 0.001 |
TC (mmol/L) | 4.76 ± 0.87 | 4.85 ± 0.87 | 4.89 ± 0.89 | 5.02 ± 0.94 | 5.04 ± 0.92 | < 0.001 |
HDL-C (mmol/L) | 1.65 ± 0.39 | 1.59 ± 0.37 | 1.52 ± 0.37 | 1.45 ± 0.33 | 1.39 ± 0.34 | < 0.001 |
LDL-C (mmol/L) | 2.58 ± 0.66 | 2.69 ± 0.65 | 2.74 ± 0.69 | 2.86 ± 0.73 | 2.86 ± 0.71 | < 0.001 |
AST (U/L) | 21.01 ± 5.32 | 22.47 ± 9.81 | 22.79 ± 9.60 | 23.89 ± 9.28 | 25.22 ± 11.71 | < 0.001 |
ALT (U/L) | 16.57 ± 7.75 | 18.89 ± 16.35 | 19.71 ± 13.44 | 21.83 ± 13.53 | 22.86 ± 17.66 | < 0.001 |
FPG (mmol/L) | 5.96 ± 1.50 | 5.93 ± 1.16 | 5.91 ± 0.90 | 6.09 ± 1.26 | 6.15 ± 1.14 | 0.024 |
SUA (μmol/L) | 185.58 ± 21.50 | 228.54 ± 8.94 | 260.37 ± 9.29 | 296.96 ± 12.55 | 378.07 ± 54.56 | < 0.001 |
Hyper-ALT, n (%) | 14 (1.6) | 30 (3.4) | 47 (5.2) | 64 (7.3) | 85 (9.4) | < 0.001 |
NAFLD, n (%) | 82 (9.4) | 152 (17.3) | 226 (24.8) | 355 (40.4) | 447 (49.6) | < 0.001 |
M-steatosis, n (%) | 31 (3.6) | 59 (6.7) | 82 (9.0) | 106 (12.1) | 108 (12.0) | < 0.001 |
S-steatosis, n (%) | 51 (5.8) | 93 (10.6) | 144 (15.8) | 249 (28.4) | 339 (37.6) | < 0.001 |
Associations of SUA levels with NAFLD
SUA levels | Cases/n (%) | Model 1 | Model 2 | ||||
---|---|---|---|---|---|---|---|
OR | 95% CI |
P
| OR | 95% CI |
P
| ||
Total (n = 7569) | |||||||
Q1 | 176/1523 (11.6) | 1 | 1 | ||||
Q2 | 338/1536 (22.0) | 2.41 | 1.97–2.95 | < 0.001 | 1.78 | 1.41–2.23 | < 0.001 |
Q3 | 473/1521 (31.1) | 4.39 | 3.61–5.34 | < 0.001 | 2.85 | 2.27–3.58 | < 0.001 |
Q4 | 540/1481 (36.5) | 6.31 | 5.16–7.72 | < 0.001 | 3.19 | 2.52–4.04 | < 0.001 |
Q5 | 702/15,084 (6.6) | 10.92 | 8.88–13.44 | < 0.001 | 4.34 | 3.39–5.54 | < 0.001 |
Men (n = 3126) | |||||||
Q1 | 98/603 (16.3) | 1 | 1 | ||||
Q2 | 147/646 (22.8) | 1.48 | 1.11–1.97 | 0.008 | 1.20 | 1.01–1.84 | 0.281 |
Q3 | 197/617 (31.9) | 2.38 | 1.80–3.14 | < 0.001 | 1.57 | 1.14–2.17 | 0.006 |
Q4 | 221/629 (35.1) | 2.93 | 2.22–3.86 | < 0.001 | 1.94 | 1.41–2.67 | < 0.001 |
Q5 | 304/631 (48.2) | 5.26 | 4.01–6.90 | < 0.001 | 2.74 | 2.00–3.76 | < 0.001 |
Women (n = 4443) | |||||||
Q1 | 82/873 (9.4) | 1 | 1 | ||||
Q2 | 152/881 (17.3) | 2.04 | 1.53–2.71 | < 0.001 | 1.70 | 1.24–2.34 | 0.001 |
Q3 | 226/910 (24.8) | 3.27 | 2.48–4.29 | < 0.001 | 2.27 | 1.67–3.08 | < 0.001 |
Q4 | 355/878 (40.4) | 6.83 | 5.23–8.91 | < 0.001 | 4.07 | 3.02–5.48 | < 0.001 |
Q5 | 447/901 (49.6) | 10.19 | 7.80–13.31 | < 0.001 | 4.60 | 3.39–6.24 | < 0.001 |
SUA levels | Mild-steatosis | Severe-steatosis | ||||||
---|---|---|---|---|---|---|---|---|
Cases/n (%) | OR | 95% CI |
P
| Cases/n (%) | OR | 95% CI |
P
| |
Severity of steatosis (Model 1) | ||||||||
Total (n = 7569) | ||||||||
Q1 | 72/1419 (5.1) | 1 | 104/1451 (7.2) | 1 | ||||
Q2 | 126/1324 (9.5) | 2.10 | 1.55–2.84 | < 0.001 | 212/1410 (15.0) | 2.61 | 2.03–3.34 | < 0.001 |
Q3 | 180/1228 (14.7) | 3.67 | 2.74–4.92 | < 0.001 | 293/1341 (21.8) | 4.81 | 3.77–6.13 | < 0.001 |
Q4 | 175/1116 (15.7) | 4.16 | 3.07–5.64 | < 0.001 | 365/1306 (27.9) | 7.87 | 6.16–10.05 | < 0.001 |
Q5 | 216/1022 (21.1) | 6.52 | 4.78–8.88 | < 0.001 | 486/1292 (37.6) | 14.36 | 11.18–18.46 | < 0.001 |
Men (n = 3126) | ||||||||
Q1 | 43/548 (7.8) | 1 | 55/560 (9.8) | 1 | ||||
Q2 | 77/576 (13.4) | 1.76 | 1.19–2.62 | 0.005 | 70/569 (12.3) | 1.25 | 0.86–1.83 | 0.239 |
Q3 | 80/500 (16.0) | 2.20 | 1.48–3.26 | < 0.001 | 117/537 (21.8) | 2.51 | 1.78–3.56 | < 0.001 |
Q4 | 88/496 (17.7) | 2.66 | 1.80–3.92 | < 0.001 | 133/541 (24.6) | 3.14 | 2.23–4.43 | < 0.001 |
Q5 | 95/422 (22.5) | 3.75 | 2.54–5.53 | < 0.001 | 209/536 (39.0) | 6.44 | 4.62–8.98 | < 0.001 |
Women (n = 4443) | ||||||||
Q1 | 31/822 (3.8) | 51/842 (6.1) | ||||||
Q2 | 59/788 (7.5) | 2.12 | 1.35–3.31 | 0.001 | 93/822 (11.3) | 1.99 | 1.40–2.85 | < 0.001 |
Q3 | 82/766 (10.7) | 3.21 | 2.09–4.91 | < 0.001 | 144/828 (17.4) | 3.31 | 2.37–4.63 | < 0.001 |
Q4 | 106/629 (16.9) | 5.61 | 3.69–8.52 | < 0.001 | 249/772 (32.3) | 7.57 | 5.48–10.45 | < 0.001 |
Q5 | 108/562 (19.2) | 6.94 | 4.55–10.60 | < 0.001 | 339/793 (42.7) | 12.06 | 8.75–16.63 | < 0.001 |
Severity of steatosis (Model 2) | ||||||||
Total (n = 7569) | ||||||||
Q1 | 72/1419 (5.1) | 1 | 104/1451 (7.2) | 1 | ||||
Q2 | 126/1324 (9.5) | 1.70 | 1.24–2.32 | 0.001 | 212/1410 (15.0) | 1.86 | 1.39–2.48 | < 0.001 |
Q3 | 180/1228 (14.7) | 2.73 | 2.01–3.71 | < 0.001 | 293/1341 (21.8) | 2.98 | 2.24–3.96 | < 0.001 |
Q4 | 175/1116 (15.7) | 2.66 | 1.93–3.67 | < 0.001 | 365/1306 (27.9) | 3.71 | 2.77–4.96 | < 0.001 |
Q5 | 216/1022 (21.1) | 3.48 | 2.50–4.86 | < 0.001 | 486/1292 (37.6) | 5.18 | 3.83–7.01 | < 0.001 |
Men (n = 3126) | ||||||||
Q1 | 43/548 (7.8) | 1 | 55/560 (9.8) | 1 | ||||
Q2 | 77/576 (13.4) | 1.47 | 0.97–2.22 | 0.067 | 70/569 (12.3) | 0.95 | 0.62–1.47 | 0.815 |
Q3 | 80/500 (16.0) | 1.67 | 1.11–2.53 | 0.015 | 117/537 (21.8) | 1.50 | 0.99–2.25 | 0.053 |
Q4 | 88/496 (17.7) | 1.95 | 1.30–2.95 | 0.001 | 133/541 (24.6) | 1.96 | 1.31–2.93 | 0.001 |
Q5 | 95/422 (22.5) | 2.54 | 1.68–3.84 | < 0.001 | 209/536 (39.0) | 2.95 | 1.99–4.37 | < 0.001 |
Women (n = 4443) | ||||||||
Q1 | 31/822 (3.8) | 1 | 51/842 (6.1) | 1 | ||||
Q2 | 59/788 (7.5) | 1.89 | 1.20–2.98 | 0.006 | 93/822 (11.3) | 1.58 | 1.06–2.35 | 0.025 |
Q3 | 82/766 (10.7) | 2.42 | 1.55–3.75 | < 0.001 | 144/828 (17.4) | 2.22 | 1.52–3.24 | < 0.001 |
Q4 | 106/629 (16.9) | 4.02 | 2.61–6.20 | < 0.001 | 249/772 (32.3) | 4.21 | 2.92–6.05 | < 0.001 |
Q5 | 108/562 (19.2) | 4.17 | 2.67–6.51 | < 0.001 | 339/793 (42.7) | 4.93 | 3.41–7.12 | < 0.001 |
ALT levels | Cases/n (%) | Model 1 | Model 2 | ||||
---|---|---|---|---|---|---|---|
OR | 95% CI |
P
| OR | 95% CI |
P
| ||
Total (n = 7569) | |||||||
Q1 | 227/1899 (12.0) | 1 | 1 | ||||
Q2 | 496/2259 (22.0) | 2.09 | 1.76–2.48 | < 0.001 | 1.54 | 1.26–1.87 | < 0.001 |
Q3 | 482/1560 (30.9) | 3.37 | 2.83–4.03 | < 0.001 | 2.18 | 1.77–2.69 | < 0.001 |
Q4 | 1024/1851 (55.3) | 9.39 | 7.93–11.1 | < 0.001 | 4.96 | 3.98–6.17 | < 0.001 |
Men (n = 3126) | |||||||
Q1 | 117/921 (12.7) | 1 | 1 | ||||
Q2 | 153/684 (22.4) | 1.93 | 1.48–2.52 | < 0.001 | 1.38 | 1.02–1.86 | 0.04 |
Q3 | 264/805 (32.8) | 3.16 | 2.47–4.04 | < 0.001 | 2.03 | 1.53–2.68 | < 0.001 |
Q4 | 433/716 (60.5) | 9.51 | 7.42–12.2 | < 0.001 | 4.76 | 3.47–6.53 | < 0.001 |
Women (n = 4443) | |||||||
Q1 | 160/1314 (12.2) | 1 | 1 | ||||
Q2 | 188/924 (20.3) | 1.85 | 1.47–2.32 | < 0.001 | 1.44 | 1.11–1.88 | 0.006 |
Q3 | 401/1213 (33.1) | 3.62 | 2.95–4.44 | < 0.001 | 2.80 | 2.21–3.55 | < 0.001 |
Q4 | 513/992 (51.7) | 7.99 | 6.49–9.84 | < 0.001 | 5.53 | 4.19–7.30 | < 0.001 |
Joint associations of SUA and ALT with NAFLD prevalence
Group | Cases/n (%) | Model 1 | Model 2 | ||||
---|---|---|---|---|---|---|---|
OR | 95% CI |
P
| OR | 95% CI |
P
| ||
Total (n = 7569) | |||||||
Low ALT + low SUA | 1500/6269 (82.8) | 1 | |||||
Low ALT + elevated SUA | 411/840 (11.1) | 3.22 | 2.77–3.74 | < 0.001 | 1.94 | 1.61–2.34 | < 0.001 |
Elevated ALT + low SUA | 232/364 (4.8) | 5.34 | 4.27–6.67 | < 0.001 | 2.99 | 2.17–4.11 | < 0.001 |
Elevated ALT + elevated SUA | 86/96 (1.3) | 26.75 | 13.85–51.65 | < 0.001 | 9.15 | 4.31–19.40 | < 0.001 |
Men (n = 3126) | |||||||
Low ALT + low SUA | 613/2482 (79.4) | 1 | |||||
Low ALT + elevated SUA | 187/408 (13.1) | 2.90 | 2.33–3.61 | < 0.001 | 1.99 | 1.53–2.59 | < 0.001 |
Elevated ALT + low SUA | 119/184 (5.9) | 4.87 | 3.54–6.71 | < 0.001 | 2.78 | 1.81–4.25 | < 0.001 |
Elevated ALT + elevated SUA | 48/52 (1.7) | 30.68 | 10.97–85.77 | < 0.001 | 10.75 | 3.56–32.46 | < 0.001 |
Women (n = 4443) | |||||||
Low ALT + low SUA | 887/3787 (85.2) | 1 | |||||
Low ALT + elevated SUA | 224/432 (9.7) | 3.48 | 2.83–4.28 | < 0.001 | 2.00 | 1.55–2.58 | < 0.001 |
Elevated ALT + low SUA | 113/180 (4.1) | 5.55 | 4.06–7.58 | < 0.001 | 3.18 | 1.99–5.08 | < 0.001 |
Elevated ALT + elevated SUA | 38/44 (1.0) | 20.60 | 8.68–48.90 | < 0.001 | 7.96 | 2.83–22.39 | < 0.001 |