Abstract
BackgroundEpidemiological evidence suggests sex difference in serum uric acid (SUA) and alanine aminotransferase (ALT) might be a potential explanation for the gender difference in prevalence of non-alcoholic fatty liver disease (NAFLD). However, few epidemiology data in China have tested this hypothesis.MethodsWe conducted a cross-sectional study to assess the joint associations between SUA and serum ALT with NAFLD among elderly Chinese men and women.ResultsAmong 7569 participants with a mean age of 59.8 years (± 13.4 years), 56.6% of women and 43.4% of men were diagnosed as NAFLD, respectively. A positive association between SUA and NAFLD prevalence was observed in both men and women. NAFLD prevalence was 2.74 times (95% CI 2.00–3.76) higher for men and 4.60 times (95% CI 3.39–6.24) higher for women with the highest quintiles of SUA levels compared to those with the lowest levels. SUA levels were significantly associated with prevalence of mild- and severe-steatosis (P < 0.01). In addition, the ORs of NAFLD among participants with high SUA levels and high serum ALT was 10.75 (95% CI 3.56–32.46) for men and 7.96 (95% CI 2.83–22.39) for women, compared with those with low SUA levels and low serum ALT.ConclusionsSUA levels were positively associated with NAFLD prevalence, and the association was slightly stronger in women than in men. A significant joint association of SUA and serum ALT with NAFLD prevalence was observed in all participants, which was slightly stronger in men than in women.
Highlights
Epidemiological evidence suggests sex difference in serum uric acid (SUA) and alanine aminotransferase (ALT) might be a potential explanation for the gender difference in prevalence of non-alcoholic fatty liver disease (NAFLD)
Participants in the highest quintile of SUA (SUA ≥ 321 μmol/L) were older, with high body mass index (BMI), SBP, and diastolic blood pressure (DBP). Serum biochemical parameters, such as TG, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), ALT, and fasting plasma glucose (FPG) were positively associated with SUA levels, and high-density lipoprotein cholesterol (HDL-C) levels were negatively related to SUA levels
Our study found that SUA was positively associated with NAFLD in both men and women, whereas the association was slightly stronger in women
Summary
Epidemiological evidence suggests sex difference in serum uric acid (SUA) and alanine aminotransferase (ALT) might be a potential explanation for the gender difference in prevalence of non-alcoholic fatty liver disease (NAFLD). Increasing observational evidence suggests a close relationship between serum uric acid (SUA) levels and risk of NAFLD [2,3,4]. Recent observational studies suggest that liver damage already exist even when the level of ALT is within the normal range. A diagnosis by elevated levels of serum ALT might underestimate the prevalence of NAFLD [16,17,18]. A populationbased cross-sectional study among 82,608 adults aged 43.91 (± 10.15) years in Israel found a stronger association between uric acid and elevated ALT among women than men [21]. The gender difference for the ALT-SUA association possibly contributes to the gender difference for the NAFLD prevalence, and might help to explain the reason why ALT underestimated the NAFLD prevalence
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