Association between cumulative uric acid exposure and metabolic dysfunction-associated fatty liver disease

To explore the impact of cumulative uric acid (cum UA) exposure on the incidence of metabolic dysfunction-associated fatty liver disease (MAFLD).

This prospective cohort study analyzed 21,333 active and retired employees who completed three consecutive health examinations (2006, 2008, 2010), with a mean follow-up time of 6.24 years (SD = 2.59) revealing 8,280 (38.81%) incident MAFLD cases. Participants were stratified into quartiles (Q1-Q4) based on cum UA levels measured across the triennial assessments. Kaplan-Meier survival curves quantified cumulative MAFLD incidence rates across quartiles, followed by multivariable-adjusted Cox proportional hazards regression models to evaluate dose-response relationships between cum UA exposure and MAFLD risk.

Following comprehensive adjustment for confounding variables, multivariable analysis revealed progressively elevated hazard ratios for MAFLD development across cum UA quartiles. Compared to the reference quartile 1 (Q1), adjusted HRs (95% CI) were 1.055 (0.989-1.125) for Q2, 1.202 (1.126-1.284) for Q3, and 1.237 (1.154-1.326) for Q4. Restricted cubic spline (RCS) analysis confirmed a significant non-linear dose-response relationship between cumulative UA exposure and MAFLD risk (non-linearity association P < 0.05). The Kaplan-Meier Survival Curves showed significantly diverging cumulative incidence rates across quartiles (Log-rank χ²=87.98; P < 0.001). Incidence densities followed an ascending pattern: 55.07 (Q1), 58.46 (Q2), 66.34 (Q3), and 67.12 cases/1,000 person-years (Q4). Corresponding cumulative incidence rates were 52.20%, 52.49%, 58.29%, and 60.50% respectively. Stratified analysis was performed for gender, abdominal obesity, and smoking. Gender stratification: Q4 HR = 1.315 (1.216-1.422) in males vs. 1.079 (0.953-1.223) in females. Abdominal obesity status: Q4 HR = 1.208 (1.082-1.349) in obese vs. 1.348 (1.237-1.468) in non-obese. Smoking status: Q4 HR = 1.385 (1.238-1.549) in smoking vs. 1.186 (1.087-1.295) in non-smoking. Sensitivity analyses excluding participants with baseline chronic kidney disease (CKD) or follow-up time < 2 years demonstrated comparable risk gradients, confirming the robustness of our primary findings.

This study found that cum UA is an independent risk factor for MAFLD. In this longitudinal cohort analysis, both the cumulative incidence and the risk of developing MAFLD increased as the cum UA level rose. Among all the participants, especially subjects who regularly engage in physical exercise, males, individuals with abdominal obesity, and smokers have a higher risk of developing MAFLD.

trial registration number ChiCTRTNC11001489, registration date 20,110,824, registration institution Chinese Clinical Trial Registry, registration site: http://www.chictr.org.cn/index.aspx .