Association of serum uric acid level and body mass index between non alcoholic fatty liver disease patients and healthy volunteers

Mohan Jayabal, Rashmi Ramanathan, Lathadevi Velliangiri, Dinesh Thangavel, Venkatesan Rangan, Venkidusamy Subramaniam


Background: Non-alcoholic fatty liver disease (NAFLD) is considered as a hepatic manifestation of the metabolic syndrome. Worldwide prevalence of NAFLD is 38%. Serum uric acid level has been suggested to be associated with factors that contribute to insulin resistance and metabolic syndrome. The aim of this study is to investigate the association of serum uric acid level and body mass index (BMI) with NAFLD.

Methods: This observational study was conducted in subjects, who attended the master health checkup clinic of PSG Hospitals, Coimbatore, on 50 patients with NAFLD and 50 non fatty liver subjects. NAFLD was diagnosed based on the abdominal ultrasonographic findings. BMI and serum uric acid level were also measured in all the study participants. Uric acid quartiles were categorized into four groups, and the number of subjects, who came under each group, was noted.

Results: The mean BMI (kg/m²) for cases was 27.01 ± 3.53 and the same for controls was 23.91 ± 3.11. Elevated BMI was associated with an increased incidence of NAFLD with a statistical significance (p < 0.05).The mean uric acid concentration (mg/dl) for cases was 5.73 ± 1.57, and for controls was 4.69 ± 0.91. Increased serum uric acid concentration was associated with an increased incidence of NAFLD with a statistical significance (p < 0.05).

Conclusion: This study showed that elevated BMI is associated with an increased incidence of NAFLD. Serum uric acid levels are significantly associated with NAFLD, and high uric acid levels showed a high incidence of NAFLD compared to low serum uric acid level.


Non-alcoholic fatty liver disease, Uric acid, Body mass index

Full Text:



Harrison R. Structure and function of xanthine oxidoreductase: where are we now? Free Radic Biol Med. 2002;33(6):774-97.

Hediger MA, Johnson RJ, Miyazaki H, Endou H. Molecular physiology of urate transport. Physiology (Bethesda). 2005;20:125-33.

Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413-9.

Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003;37(4):917-23.

Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50(8):1844-50.

Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003;9(3):237 52.

Targher G, Bertolini L, Poli F, Rodella S, Scala L, Tessari R, et al. Nonalcoholic fatty liver disease and risk of future cardiovascular events among type 2 diabetic patients. Diabetes. 2005;54(12):3541-6.

Chen L, Zhu W, Chen Z, Dai H, Ren J, Chen J, et al. Relationship between hyperuricemia and metabolic syndrome. J Zhejiang Univ. 2007;8(8):593-8.

Yoo TW, Sung KC, Shin HS, Kim BJ, Kim BS, Kang JH, et al. Relationship between serum uric acid concentration and insulin resistance and metabolic syndrome. Circ J. 2005;69(8):928-33.

Afzali A, Weiss NS, Boyko EJ, Ioannou GN. Association between serum uric acid level and chronic liver disease in the United States. Hepatology. 2010;52(2):578-89.

Shi JP, Fan JG, Wu R, Gao XQ, Zhang L, Wang H, et al. Prevalence and risk factors of hepatic steatosis and its impact on liver injury in Chinese patients with chronic hepatitis B infection. J Gastroenterol Hepatol. 2008;23(9):1419-25.

Li Y, Xu C, Yu C, Xu L, Miao M. Association of serum uric acid level with non-alcoholic fatty liver disease: a cross-sectional study. J Hepatol. 2009;50(5):1029 34.

Park SH, Kim BI, Yun JW, Kim JW, Park DI, Cho YK, et al. Insulin resistance and C-reactive protein as independent risk factors for non-alcoholic fatty liver disease in non-obese Asian men. J Gastroenterol Hepatol. 2004;19(6):694-8.

Sui X, Church TS, Meriwether RA, Lobelo F, Blair SN. Uric acid and the development of metabolic syndrome in women and men. Metabolism. 2008;57(6):845-52.

Kanellis J, Watanabe S, Li JH, Kang DH, Li P, Nakagawa T, et al. Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2. Hypertension. 2003;41(6):1287-93.

Hotamisligil GS, Arner P, Caro JF, Atkinson RL, Spiegelman BM. Increased adipose tissue expression of tumor necrosis factor-alpha in human obesity and insulin resistance. J Clin Invest. 1995;95(5):2409-15.

Zelber-Sagi S, Nitzan-Kaluski D, Halpern Z, Oren R. Prevalence of primary non-alcoholic fatty liver disease in a population-based study and its association with biochemical and anthropometric measures. Liver Int. 2006;26(7):856-63.