Association Between the Severity of Non-alcoholic Fatty Liver Disease and the Uric Acid-to-HDL Ratio

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is a common cause of elevated liver enzyme levels and is increasing in parallel with the global obesity epidemic in adults and children. Objectives: This study examined the association between liver stiffness and serum uric acid, high-density lipoprotein cholesterol (HDL), and the uric acid-to-HDL ratio (UHR) in patients with NAFLD-related fibrosis. Methods: This cross-sectional study was conducted using hospital and clinic data after ethical approval was obtained from Ahvaz Jundishapur University of Medical Sciences. Patients referred to a specialized liver center for liver fibrosis assessment who met the inclusion criteria, including liver steatosis and abnormal liver function tests, were enrolled. Data were analyzed using SPSS version 26.0. Univariable analyses were performed first. Subsequently, two generalized linear models were developed to evaluate the associations of uric acid, HDL, and UHR with elastography values after adjustment for age and sex. Results: A total of 44 participants were included in the final analysis; 23 (52.3%) were male, and the mean age was 43.97 ± 7.65 years. The mean elastography value was 8.21 ± 2.55 kPa, the mean HDL level was 39.45 ± 11.34 mg/dL, and the mean uric acid level was 5.25 ± 1.54 mg/dL. In univariable analyses, aspartate aminotransferase (AST), alanine aminotransferase (ALT), the AST/ALT ratio, uric acid, and UHR were positively associated with elastography values, whereas HDL showed an inverse association. The UHR was higher in males (P ≤ 0.01). In generalized linear models adjusted for age and sex, UHR (B = 15.71, P = 0.001) and uric acid (B = 0.608, P = 0.028) remained significantly associated with elastography values, whereas HDL showed a non-significant inverse trend. However, after additional adjustment for AST, ALT, and platelet count, these associations were attenuated and were no longer statistically significant. Conclusions: Elastography values were significantly associated with uric acid and HDL levels, indicating that liver stiffness is related to metabolic factors. The inverse association between uric acid and HDL emphasizes the pro-inflammatory role of uric acid and the protective effects of HDL in the liver.