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Hyperuricemia is associated with nonalcoholic fatty liver disease activity score in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis

Jaruvongvanich, Veeravicha,e; Ahuja, Wasinb; Wirunsawanya, Kamonkiata; Wijarnpreecha, Karnc; Ungprasert, Patompongd,f

European Journal of Gastroenterology & Hepatology: September 2017 - Volume 29 - Issue 9 - p 1031–1035
doi: 10.1097/MEG.0000000000000931
Original Articles: Metabolic Liver Disease

Background Hyperuricemia is a significant risk factor for nonalcoholic fatty liver disease (NAFLD). It may also have an impact on the histologic severity of NAFLD. However, data on this association are limited. We conducted this meta-analysis to investigate the relationship of serum uric acid with liver histologic severity as determined by NAFLD activity score (NAS) in patients with NAFLD.

Patients and methods MEDLINE and EMBASE databases were searched through August 2016 for studies that investigated the association between hyperuricemia and NAS among patients with biopsy-proven NAFLD. Pooled odds ratio and 95% confidence interval were calculated using a random-effects model (generic inverse variance method). The between-study heterogeneity of effect size was quantified using the Q statistic and I 2.

Results Five observational studies with 777 NAFLD patients were identified. Patients with NAFLD who had hyperuricemia had a high NAS (defined as score of ≥5) significantly more often than did those without hyperuricemia with a pooled odds ratio of 2.17 (95% confidence interval: 1.51–3.12). The statistical heterogeneity was low, with I 2 of 16% (P heterogeneity=0.31).

Conclusion In patients with NAFLD, hyperuricemia is associated with a higher degree of histological liver damage. Further studies are required to establish the role of uric acid-lowering therapy among these patients.

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aDepartment of Internal Medicine, University of Hawaii, Honolulu, Hawaii

bDepartment of Internal Medicine, Norwalk Hospital, Norwalk, Connecticut

cDepartment of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York

dDepartment of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA

eDepartment of Medicine, King Chulalongkorn Memorial Hospital

fDepartment of Medicine, Division of Rheumatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Correspondence to Veeravich Jaruvongvanich, MD, Department of Internal Medicine, University of Hawaii, Honolulu, HI 96817, USA Tel: +1 808 542 1939; fax: +1 808 586 7486; e-mail:

Received March 15, 2017

Accepted June 1, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.