Relationship Between Serum Uric Acid-to-Creatinine Ratio and the Risk of Metabolic-Associated Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus

Figures & data

Table 1 The Demographic Data and Biochemical Parameters of the Examined Patients

	T1	T2	T3	P
Age (years)	64 (55, 73)	58 (49, 67)	53 (41.25, 64)	0.000
BMI	25.18 (22.86, 27.12)	25.48 (23.44, 27.6725)	26.42 (24.22, 28.91)	0.000
Course of DM (years)	10 (4.75, 20)	9 (3, 15)	6 (2, 12)	0.000
Males	274 (60.2%)	285 (62.6%)	263 (57.7%)	0.310
Smoking	135 (31.5%)	147 (34%)	139 (33%)	0.738
Drinking	91 (21.3%)	100 (23.1%)	123 (29.3%)	0.018
History of hypertension	267 (58.9%)	225 (49.6%)	218 (47.8%)	0.001
WBC (×10^9/L)	6.36 (5.34, 7.705)	6.18 (5.14, 7.34)	6.35 (5.22, 7.94)	0.087
N (%)	65.35 (57.8, 72.2)	61.9 (54.8, 67.7)	61.8 (56.3, 67.6)	0.000
L (%)	26.4 (20.475, 32.8)	30.4 (24.5, 36.1)	30.4 (24.6, 35.3)	0.000
ALT (U/L)	16.4 (11.9, 23.2)	18.8 (13.3, 27.325)	19.8 (14.8, 32.5)	0.000
AST (U/L)	18.1 (14.575, 21.925)	19.45 (15.475, 24.1)	20 (16, 27)	0.000
GGT (U/L)	21.7 (15.6, 32.125)	24 (17.25, 39.05)	27.95 (18.7, 45.15)	0.000
BA (umol/l)	3.065 (1.91, 5.215)	3.025 (2.04, 4.4875)	2.93 (1.86, 4.8025)	0.621
FBG (mmol/l)	8.235 (5.9775, 11.2925)	8.3 (6.455, 11.365)	8.25 (6.5525, 11.175)	0.623
GFR (mL/min/1.73m^2)	84.195 (62.99, 96.2275)	93.715 (83.09, 102.27)	100.225 (88.86, 109.7)	0.000
TC (mmol/l)	4.43 (3.68, 5.285)	4.67 (3.8875, 5.445)	4.855 (4.1125, 5.6175)	0.000
TG (mmol/l)	1.2 (0.9, 1.815)	1.425 (1.0275, 2.0825)	1.75 (1.22, 2.81)	0.000
HDL (mmol/l)	1.02 (0.86, 1.24)	1.03 (0.88, 1.2)	1.01 (0.86, 1.19)	0.614
LDL (mmol/l)	2.9 (2.32, 3.5)	3.02 (2.4575, 3.63)	3.12 (2.6, 3.72)	0.001
VLDL (mmol/l)	0.47 (0.325, 0.695)	0.535 (0.37, 0.7775)	0.59 (0.42, 0.85)	0.000
HBA1C (%)	8.6 (7.5, 10.4)	8.7 (7.3, 10.5)	8.6 (7.2, 10.5)	0.727

Note: Non-parametric tests and χ² test were used and differences were considered statistically significant at P values of <0.05.

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BA, bile acid; BMI, body mass index; DM, diabetes mellitus; FBG, fasting blood glucose; GFR, glomerular filtration rate; GGT, gamma glutamyl transpeptidase; HbA1C, glycosylated hemoglobin; HDL, high-density lipoprotein; LDL, low-density lipoprotein; N, neutrophils; L, lymphocytes;TC, total cholesterol; TG, triglycerides; VLDL, very low-density lipoprotein; WBC, white blood cell.

Figure 1 Flowchart of the patient selection process.

Figure 2 Comparison of serum uric acid-to-creatinine ratio (SUA/Cr) between the metabolic-associated fatty liver disease (MAFLD) group and the non-MAFLD group in participants with type 2 diabetes mellitus (T2DM).

Figure 3 Comparison of the prevalence of metabolic-associated fatty liver disease (MAFLD) in patients with type 2 diabetes mellitus (T2DM) who have different serum uric acid-to-creatinine ratios (SUA/Cr).

Figure 4 Spearman correlation analysis of serum uric acid-to-creatinine ratio (SUA/Cr) with potential risk factors for metabolic-associated fatty liver disease (MAFLD). (A) All patients with type 2 diabetes mellitus (T2DM), (B) patients with T2DM but without MAFLD, (C) patients with T2DM and MAFLD.

Table 2 Logistic Regression Analysis of SUA/Cr for MAFLD in Patients with T2DM

Outcomes	Model 1		Model 2		Model 3
	OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p
SUA/Cr
T1	Ref		Ref		Ref
T2	1.646 (1.266, 2.141)	P<0.001	1.53 (1.13, 2.073)	0.006	1.432 (1.031, 1.991)	0.032
T3	2.468 (1.890, 3.222)	P<0.001	1.71 (1.239, 2.361)	0.001	1.498 (1.047, 2.142)	0.027
P for trend	P<0.001		0.002		0.047

Notes: Model 1: crude model; Model 2: adjusted for sex, age, BMI, DM course, drinking, smoking, history of hypertension; Model 3: further adjusted for TC, TG, HDL, LDL, VLDL, AST, ALT, GGT, BA, GFR, FBG, HBA1C.

Abbreviations: CI, confidence interval; MAFLD, metabolic-associated fatty liver disease; OR, odds ratio; T, tertile; SUA/Cr, serum uric acid-to-creatinine ratio; T2DM, type 2 diabetes mellitus.

Table 3 Effect of Magnitude of SUA/Cr on MAFLD Risk Stratified by Subgroups

Characteristics	No. of Participants	OR (95% CI)	P-value	P for Interaction
Age				0.091
≤40	187	2.082 (0.396, 10.939)	0.386
>40, ≤60	583	1.498 (1.047, 2.142)	0.027
>60	673	1.162 (0.685, 1.97)	0.578
Sex				0.009
Males	855	1.166 (0.725, 1.876)	0.527
Females	579	2.311 (1.261, 4.237)	0.007
Smoking				0.832
No	966	1.792 (1.14, 2.819)	0.012
Yes	448	1.328 (0.705, 2.5)	0.38
Drinking				0.277
No	1082	1.527 (0.993, 2.35)	0.054
Yes	352	1.231 (0.604, 2.508)	0.567
Hypertension				0.247
No	688	1.989 (1.147, 3.450)	0.014
Yes	746	1.180 (0.717, 1.943)	0.514
DM Course				0.855
≤5	522	0.948 (0.517, 1.737)	0.862
>5,≤10	344	1.498 (1.047, 2.142)	0.027
>10	569	2.142 (1.177, 3.896)	0.013
BMI				0.038
<23	307	2.37 (0.903, 6.221)	0.08
≥23, <28	791	1.498 (1.047, 2.142)	0.027
≥28	336	2.129 (0.855, 5.303)	0.105
HBA1C				0.011
≤7	297	0.817 (0.319, 2.096)	0.675
>7	1137	1.726 (1.158, 2.573)	0.007

Notes: The model was adjusted sex, age, BMI, DM course, drinking, smoking, history of hypertension, TC, TG, HDL, LDL, VLDL, AST, ALT, GGT, BA, GFR, FBG, HBA1C.

Abbreviations: BMI, body mass index; CI, confidence interval; HbA1C, glycosylated hemoglobin; MAFLD, metabolic-associated fatty liver disease; OR, odds ratio; SUA/Cr, serum uric acid-to-creatinine ratio; DM, diabetes mellitus.