Association of Uric Acid to Creatinine Ratio with Metabolic Dysfunction-Associated Fatty Liver in Non-Obese Individuals Without Type 2 Diabetes Mellitus

Figures & data

Figure 1 Flow chart of the study subjects.

Abbreviations: MAFLD, metabolic dysfunction-associated fatty liver disease; BMI, body mass index; T₂DM, type 2 diabetes mellitus.

Table 1 Baseline and Clinical Characteristics of Participants with and without Metabolic Dysfunction-Associated Fatty Liver Disease (n=21,996)

	MAFLD (n =7262)	Non-MAFLD (n =14,734)	p
Male [n (%)]	5465 (75.3%)	6121 (41.5%)	0.000
Female [n (%)]	1797 (24.7%)	8613 (58.5%)
Obesity without T2DM [n (%)]	5903 (81.3%)	5562 (37.7%)	0.000
Non-obesity without T2DM [n (%)]	369 (5.1%)	8855 (60.1%)	0.000
Obesity with T2DM [n (%)]	923 (12.7%)	214 (1.5%)	0.000
Non-obesity with T2DM [n (%)]	67 (0.9%)	103 (0.7%)	0.075
Age (years)	44.16±11.66	38.72±11.02	0.000
BMI (kg/m^2)	27.13±3.31	22.39±2.89	0.000
UA (μ mol/L)	380.79±88.34	306.84±81.58	0.000
Cr (μ mol/L)	70.20±17.48	64.03±14.31	0.000
sUA/Cr	5.54±1.31	4.86±1.10	0.000
FPG (mmol/L)	5.89±1.54	5.19±0.67	0.000
TG (mmol/L)	2.10±1.57	1.09±0.69	0.000
TC (mmol/L)	5.36±0.99	5.10±0.92	0.000
HDL-C (mmol/L)	1.22±0.34	1.46±0.34	0.000
LDL-C (mmol/L)	3.04±0.74	2.72±0.70	0.000
Dyslipidemia [n (%)]	5900 (81.2%)	7364 (50.0%)	0.000
ALT (mmol/L)	37.77±28.21	20.01±17.46	0.000
AST (mmol/L)	25.13±11.82	20.59±8.25	0.000
GGT (IU/L)	38.83±34.92	20.74±20.39	0.000
Abnormal liver function [n (%)]	2658 (36.6%)	1127 (7.6%)	0.000
Tbil (μ mol/L)	12.93±5.20	13.15±5.49	0.004
SBP (mm Hg)	129.60±16.39	117.13±15.33	0.000
DBP (mm Hg)	77.99±11.45	69.64±10.34	0.000
Hypertension [n (%)]	3626 (49.9%)	3091 (21.0%)	0.000
WC (cm)	96.14±9.10	82.33±9.37	0.000
Smoking history [n (%)]	1748 (24.1%)	1417 (9.6%)	0.000

Notes: Data were expressed as mean ± standard deviation and analyzed by student’s t test for continuous variables or expressed as number (percentage) and analyzed by chi-square test for categorical variables.

Abbreviations: MAFLD, metabolic dysfunction-associated fatty liver disease; T₂DM, type 2 diabetes mellitus; BMI, body mass index; UA, uric acid; Cr, creatinine; sUA/Cr, serum uric acid to creatinine ratio; FPG, fasting plasma glucose; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; ALT, alanine transaminase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase; TBil, total bilirubin; SBP, systolic blood pressure; DBP, diastolic blood pressure; WC, waist circumference.

Figure 2 The serum uric acid to creatinine ratio value in metabolic dysfunction-associated fatty liver disease and its subgroups. (A) sUA/Cr values in different subgroups. (B) sUA/Cr values in different sex groups. (C) sUA/Cr values in different age groups (years). Data were expressed as mean ± standard deviation () and analyzed by student’s t test.

Abbreviations: MAFLD, metabolic dysfunction-associated fatty liver disease; sUA/Cr, serum uric acid to creatinine ratio; T₂DM, type 2 diabetes mellitus.

Figure 3 The univariate correlation analysis between serum uric acid to creatinine ratio and metabolic dysfunction-associated fatty liver diseases. (A) Univariate ORs of sUA/Cr in MAFLD and its subgroups. (B) Univariate ORs of sUA/Cr in MAFLD and its subgroups in males. (C) Univariate ORs of sUA/Cr in MAFLD and its subgroups in females. (D) Univariate ORs of sUA/Cr in MAFLD and its subgroups aged 18–39 years old. (E) Univariate ORs of sUA/Cr in MAFLD and its subgroups aged 40–59 years old. (F) Univariate ORs of sUA/Cr in MAFLD and its subgroups aged ≥60 years old.

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

Figure 4 The multivariate correlation analysis between serum uric acid to creatinine ratio and metabolic dysfunction-associated fatty liver diseases. (A) Multivariate ORs of sUA/Cr in MAFLD and its subgroups. (B) Multivariate ORs of sUA/Cr in MAFLD and its subgroups in males. (C) Multivariate ORs of sUA/Cr in MAFLD and its subgroups in females. (D) Multivariate ORs of sUA/Cr in MAFLD and its subgroups aged 18–39 years. (E) Multivariate ORs of sUA/Cr in MAFLD and its subgroups aged 40–59 years. (F) Multivariate ORs of sUA/Cr in MAFLD and its subgroups aged ≥60 years.

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

Table 2 Receiver Operating Characteristics Analysis of Serum Uric Acid to Creatinine Ratio in Predicting the Risk of Metabolic Dysfunction-Associated Fatty Liver Disease in Different Groups

	Varibles	AUC	95% CI	p value	Cutoff Points	Youden Index	Sensibility (%)	Specificity (%)
MAFLD
	Overall	0.660	(0.654,0.666)	<0.0001	5.038	0.2400	62.56	61.44
	Male	0.639	(0.630,0.647)	<0.0001	5.035	0.2085	60.24	60.61
	Female	0.714	(0.705,0.723)	<0.0001	5.223	0.3230	64.27	68.03
	Age 18–39	0.692	(0.684,0.700)	<0.0001	5.096	0.2860	66.73	61.86
	Age 40–59	0.652	(0.642,0.662)	<0.0001	5.038	0.2323	58.69	64.54
	Age ≥60	0.626	(0.601,0.652)	<0.0001	5.212	0.2080	52.53	68.28
Obesity without T2DM
	Overall	0.626	(0.617,0.634)	<0.0001	5.249	0.1840	55.24	63.16
	Male	0.621	(0.611,0.632)	<0.0001	5.238	0.1765	53.21	64.44
	Female	0.659	(0.643,0.675)	<0.0001	5.123	0.2403	67.43	56.59
	Age 18–39	0.648	(0.635,0.660)	<0.0001	5.130	0.2170	65.63	56.07
	Age 40–59	0.617	(0.603,0.630)	<0.0001	5.038	0.1793	58.21	59.72
	Age ≥60	0.599	(0.563,0.635)	<0.0001	5.356	0.1841	45.48	72.93
Non-obesity without T2DM
	Overall	0.667	(0.657,0.676)	<0.0001	5.102	0.2569	58.27	67.42
	Male	0.671	(0.652,0.690)	<0.0001	4.578	0.2946	81.29	48.17
	Female	0.665	(0.654,0.676)	<0.0001	5.395	0.2581	50.00	75.81
	Age 18–39	0.637	(0.624,0.649)	<0.0001	4.912	0.2482	65.62	59.19
	Age 40–59	0.698	(0.680,0.715)	<0.0001	4.589	0.3062	79.59	51.03
	Age ≥60	0.704	(0.652,0.752)	<0.0001	5.298	0.3295	57.78	75.17
Obesity with T2DM
	Overall	0.620	(0.591,0.648)	<0.0001	4.719	0.2151	72.91	48.60
	Male	0.612	(0.580,0.644)	<0.0001	4.719	0.2036	70.08	50.28
	Female	0.603	(0.537,0.666)	0.0755	4.885	0.2858	80.10	48.48
	Age 18–39	0.588	(0.502,0.671)	0.2802	5.409	0.2097	70.97	50.00
	Age 40–59	0.612	(0.575,0.648)	0.0001	4.971	0.1957	63.37	56.20
	Age ≥60	0.615	(0.557,0.672)	0.0018	5.341	0.2461	51.89	72.73
Non-obesity with T2DM
	Overall	0.633	(0.556,0.706)	0.0019	4.632	0.2518	77.61	47.57
	Male	0.590	(0.485,0.689)	0.1323	4.926	0.2167	58.33	63.33
	Female	0.675	(0.556,0.780)	0.0049	4.632	0.3773	93.55	44.19
	Age 18–39	0.583	(0.317,0.818)	0.5779	5.482	0.4000	100.00	40.00
	Age 40–59	0.718	(0.611,0.809)	0.0001	4.926	0.3851	70.59	67.92
	Age ≥60	0.547	(0.421,0.669)	0.5090	4.645	0.1898	81.48	37.50

Abbreviations: MAFLD, metabolic dysfunction-associated fatty liver disease; T₂DM, type 2 diabetes mellitus; AUC, area under curve; CI, confidence interval.

Figure 5 Receiver operating characteristics analysis of serum uric acid to creatinine ratio in predicting the risk of MAFLD in different groups. (A) ROC of overall MAFLD. (B) ROC of obesity without T₂DM. (C) ROC of non-obesity without T₂DM. (D) ROC of obesity with T₂DM. (E) ROC of non-obesity with T₂DM.

Abbreviations: ROC, receiver operating characteristics; MAFLD, metabolic dysfunction-associated fatty liver disease; T₂DM, type 2 diabetes mellitus.