title: The association between the serum levels of uric acid and alanine aminotransferase in a population-based cohort.
abstract: OBJECTIVE
  Elevated serum uric acid levels reflect and also cause both oxidative stress and insulin resistance and are frequently observed in patients with the metabolic syndrome. A strong association exists between the metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). Therefore, we aimed to test the association between uric acid and elevated alanine aminotransferase (ALT), as a surrogate for NAFLD, using real-world data.
  
  
  METHODS
  Data used for the cross-sectional study were obtained from Maccabi Healthcare System, a 2-million member health maintenance organization in Israel. The population consisted of individuals aged 20-60 years who underwent blood tests for ALT and uric acid between 1997 and 2012. Individuals with secondary liver disease, celiac, and inflammatory bowel-disease were excluded. Subgroup analysis was performed in subjects who were given the diagnosis of fatty liver in their medical records (n = 2628).
  
  
  RESULTS
  The study population included 82,608 people (32.5% men, mean age 43.91 ± 10.15 years). There was a significant positive dose-response association between serum uric acid levels and the rate of elevated serum ALT (P for trend <0.001). In multivariable model, controlling for potential confounders, the association between uric acid and elevated ALT persisted (OR = 2.10, 95% CI 1.93-2.29, for the fourth quartile vs. the first). This association was maintained in all categories of gender and BMI. Similar results were observed among patients diagnosed with fatty liver (OR = 1.77, 1.22-2.57).
  
  
  CONCLUSIONS
  Serum uric acid is independently associated with elevated ALT, as a surrogate for NAFLD, and thus may serve as a serum marker for liver damage and should be further investigated as a risk factor for NAFLD.
authors.affiliation: School of Public Health, University of Haifa, Haifa, Israel.|The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Shira
authors.initials: S
authors.lastname: Zelber-Sagi
authors.affiliation: Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel.
authors.forename: Ofir
authors.initials: O
authors.lastname: Ben-Assuli
authors.affiliation: The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Liane
authors.initials: L
authors.lastname: Rabinowich
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Goldstein
authors.affiliation: School of Public Health, University of Haifa, Haifa, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Magid
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Varda
authors.initials: V
authors.lastname: Shalev
authors.affiliation: The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Shibolet
authors.affiliation: Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chodick
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood*; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood*; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid; D000410:Alanine Transaminase
keywords: metabolic syndrome; nonalcoholic fatty liver disease; real-world data; uric acid