THE ASSOCIATION OF SERUM URIC ACID WITH NON-ALCOHOLIC FATTY LIVER DISEASE – A CASE CONTROL STUDY IN A TERTIARY HOSPITAL IN NORTH KARNATAKA
Main Article Content
Keywords
NAFLD, Uric acid, Fatty liver, Liver Steatosis.
Abstract
BACKGROUND AND OBJECTIVES:
Need for the study:
Non alcoholic fatty liver disease is one of the most prevalent causes of liver cirrhosis in the world. [1]
Cell line studies show - Higher uric acid induces hepatocyte fat accumulation. [2]
Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress. [3]. This prompts the need for further research.
METHODS:
Source of data: The data is sourced from the patients visiting the department of General medicine in HSK Hospital, SNMC, Bagalkot.
Inclusion criteria:
Adults - aged more than 18 and less than 60 years.
Cases – ultrasonological features of fatty liver.
Controls – Age and gender matched individuals with no ultrasonological liver abnormality.
Exclusion criteria:
- History of alcohol consumption.
- Hepatitis B or Hepatitis C reactive patients.
- Those suffering from viral hepatitis.
- History of cancer.
- Those on medications that lead to hyperuricemia.
RESULTS:
1. The mean uric acid levels were 6.4 ± 2.3 in cases compared to 3.9 ± 1.6 in the controls. The difference in between these levels (overall) is statistically significant with a p values of <0.001.
- The mean uric acid levels among those with normal echogenecity was 3.87 ± 1.63, vs. those with grade 1 fatty liver changes who had levels of 5.96 ± 2.05 and those with grade 2 having values of 8 ± 2.53.
INTERPRETATION:
As per the analysis a higher mean value of Serum uric acid is associated with an increasing grade of fatty liver.
The findings of the study have both diagnostic and therapeutic applicability.
CONCLUSION:
The study performed shows a statistically significant association between the levels of serum uric acid and the presence of non alcoholic fatty liver disease (NAFLD), with elevated levels correlating with the presence of the condition and higher serum levels corresponding with increased grades of NAFLD.
References
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3. Lanaspa MA, Sanchez-Lozada LG, Choi YJ, Cicerchi C, Kanbay M, Roncal-Jimenez CA, Ishimoto T, Li N, Marek G, Duranay M, Schreiner G. Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress: potential role in fructose-dependent and-independent fatty liver. Journal of Biological Chemistry. 2012 Nov 23;287(48):40732-44.
4. Barshop NJ, Sirlin CB, Schwimmer JB, Lavine JE. epidemiology, pathogenesis and potential treatments of paediatric non‐alcoholic fatty liver disease. Alimentary pharmacology & therapeutics. 2008 Jul;28(1):13-24.
5. JG F. Epidemiology of non-alcoholic fatty liver disease in China. J Hepatol. 2009;50:204-10.
6. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL, Asia–Pacific Working Party on NAFLD1. How common is non‐alcoholic fatty liver disease in the Asia–Pacific region and are there local differences?. Journal of gastroenterology and hepatology. 2007 Jun;22(6):788-93.
7. Fracanzani AL, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E, Bertelli C, Fatta E, Bignamini D, Marchesini G, Fargion S. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008 Sep;48(3):792-8.
8. Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, McCullough AJ, Natale S, Forlani G, Melchionda N. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001 Aug 1;50(8):1844-50.
9. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, Natale S, Vanni E, Villanova N, Melchionda N, Rizzetto M. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003 Apr 1;37(4):917-23.
10. ul Haq A, Mahmood R, Ahmad Z, ur Rehman J, Jilani G. Association of serum uric acid with blood urea and serum creatinine. Pakistan Journal of Physiology. 2010 Dec 31;6(2):46-9.
11. Safi AJ, Mehmood R, Khan MA, ul Haq A. Association of Serum Urinc eAcid with Type II Diabetes Mellitus. Journal of Postgraduate Medical Institute. 2004;18(1).
12. Yoo TW, Sung KC, Shin HS, Kim BJ, Kim BS, Kang JH, Lee MH, Park JR, Kim H, Rhee EJ, Lee WY. Relationship between serum uric acid concentration and insulin resistance and metabolic syndrome. Circulation Journal. 2005;69(8):928-33.
13. Hjortnaes J, Algra A, Olijhoek J, Huisman M, Jacobs J, van der Graaf Y, Visseren F. Serum uric acid levels and risk for vascular diseases in patients with metabolic syndrome. The Journal of rheumatology. 2007 Sep 1;34(9):1882-7.
14. Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. The American journal of medicine. 2007 May 1;120(5):442-7.
15. Li Y, Xu C, Yu C, Xu L, Miao M. Association of serum uric acid level with non-alcoholic fatty liver disease: a cross-sectional study. Journal of hepatology. 2009 May 1;50(5):1029-34.
16. Abbasi S, Haleem N, Jadoon S, Farooq A. Association of non-alcoholic fatty liver disease with serum uric acid. Journal of Ayub Medical College Abbottabad. 2018 Dec 9;31(1):64-6.
17. Modan M, Halkin H, Karasik A, Lusky A. Elevated serum uric acid—a facet of hyperinsulinaemia. Diabetologia. 1987 Sep;30:713-8.
18. Quinones Galvan A, Natali A, Baldi SI, Frascerra SI, Sanna GI, Ciociaro DE, Ferrannini E. Effect of insulin on uric acid excretion in humans. American Journal of Physiology-Endocrinology and Metabolism. 1995 Jan 1;268(1):E1-5.
19. Muscelli E, Natali A, Bianchi S, Bigazzi R, Galvan AQ, Sironi AM, Frascerra S, Ciociaro D, Ferrannini E. Effect of insulin on renal sodium and uric acid handling in essential hypertension. American journal of hypertension. 1996 Aug 1;9(8):746-52.
20. Fruehwald-Schultes B, Peters A, Kern W, Beyer J, Pfützner A. Serum leptin is associated with serum uric acid concentrations in humans. Metabolism. 1999 Jun 1;48(6):677-80.
21. Matsubara M, Chiba H, Maruoka S, Katayose S. Elevated serum leptin concentrations in women with hyperuricemia. Journal of Atherosclerosis and Thrombosis. 2002;9(1):28-34.
22. Rahmouni K, Haynes WG. Endothelial effects of leptin: implications in health and diseases. Current diabetes reports. 2005 Jul;5(4):260-6.
23. Cappuccio FP, Strazzullo P, Farinaro E, Trevisan M. Uric acid metabolism and tubular sodium handling: results from a population-based study. Jama. 1993 Jul 21;270(3):354-9.
24. Nieto FJ, Iribarren C, Gross MD, Comstock GW, Cutler RG. Uric acid and serum antioxidant capacity: a reaction to atherosclerosis?. Atherosclerosis. 2000 Jan 1;148(1):131-9.
25. Waring SW, Webb DJ, Maxwell SR. Systemic uric acid administration increases serum antioxidant capacity in healthy volunteers. Journal of cardiovascular pharmacology. 2001 Sep 1;38(3):365-71.
26. Albano E, Mottaran E, Occhino G, Reale E, Vidali M. role of oxidative stress in the progression of non‐alcoholic steatosis. Alimentary pharmacology & therapeutics. 2005 Nov;22:71-3.
27. García‐Ruiz I, Rodríguez‐Juan C, Díaz‐Sanjuan T, del Hoyo P, Colina F, Muñoz‐Yagüe T, Solís‐Herruzo JA. Uric acid and anti‐TNF antibody improve mitochondrial dysfunction in ob/ob mice. Hepatology. 2006 Sep;44(3):581-91.
28. Hayden MR, Tyagi SC. Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: The urate redox shuttle. Nutrition & metabolism. 2004 Dec;1:1-5.
29. Patterson RA, Horsley ET, Leake DS. Prooxidant and antioxidant properties of human serum ultrafiltrates toward LDL: important role of uric acid. Journal of Lipid Research. 2003 Mar 1;44(3):512-21.
30. Harrison R. Structure and function of xanthine oxidoreductase: where are we now?. Free Radical Biology and Medicine. 2002 Sep 15;33(6):774-97.
31. Berry CE, Hare JM. Xanthine oxidoreductase and cardiovascular disease: molecular mechanisms and pathophysiological implications. The Journal of physiology. 2004 Mar 16;555(3):589-606.
32. Clausen JO, Borch-Johnsen K, Ibsen H, Pedersen O. Analysis of the relationship between fasting serum uric acid and the insulin sensitivity index in a population-based sample of 380 young healthy Caucasians. European journal of endocrinology. 1998 Jan;138(1):63-9.
33. Matsuura F, Yamashita S, Nakamura T, Nishida M, Nozaki S, Funahashi T, Matsuzawa Y. Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism. 1998 Aug 1;47(8):929-33.
34. Chen LY, Zhu WH, Chen ZW, Dai HL, Ren JJ, Chen JH, Chen LQ, Fang LZ. Relationship between hyperuricemia and metabolic syndrome. Journal of Zhejiang University Science B. 2007 Jul;8:593-8.
35. Schmidt MI, Watson RL, Duncan BB, Metcalf P, Brancati FL, Sharrett AR, Davis CE, Heiss G, Atherosclerosis Risk in Communities Study Investigators. Clustering of dyslipidemia, hyperuricemia, diabetes, and hypertension and its association with fasting insulin and central and overall obesity in a general population. Metabolism. 1996 Jun 1;45(6):699-706.
36. Petta S, Cammà C, Cabibi D, Di Marco V, Craxì A. Hyperuricemia is associated with histological liver damage in patients with non‐alcoholic fatty liver disease. Alimentary pharmacology & therapeutics. 2011 Oct;34(7):757-66.
37. Baldwin W, McRae S, Marek G, Wymer D, Pannu V, Baylis C, Johnson RJ, Sautin YY. Hyperuricemia as a mediator of the proinflammatory endocrine imbalance in the adipose tissue in a murine model of the metabolic syndrome. Diabetes. 2011 Apr 1;60(4):1258-69.
38. Hoque R, Vodovotz Y, Mehal W. Therapeutic strategies in inflammasome mediated diseases of the liver. Journal of hepatology. 2013 May 1;58(5):1047-52.
39. Shi Y. Caught red-handed: uric acid is an agent of inflammation. The Journal of clinical investigation. 2010 Jun 1;120(6):1809-11.
40. Kono H, Chen CJ, Ontiveros F, Rock KL. Uric acid promotes an acute inflammatory response to sterile cell death in mice. The Journal of clinical investigation. 2010 Jun 1;120(6):1939-49.
41. Shi Y, Mucsi AD, Ng G. Monosodium urate crystals in inflammation and immunity. Immunological reviews. 2010 Jan;233(1):203-17.
42. Marangella M. Uric acid elimination in the urine. Hyperuricemic syndromes: pathophysiology and therapy. 2005;147:132-48.
43. Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. American Journal of Physiology-Cell Physiology. 2007 Aug;293(2):C584-96.
44. Kang DH, Han L, Ouyang X, Kahn AM, Kanellis J, Li P, Feng L, Nakagawa T, Watanabe S, Hosoyamada M, Endou H. Uric acid causes vascular smooth muscle cell proliferation by entering cells via a functional urate transporter. American journal of nephrology. 2005 Oct 1;25(5):425-33.
45. Kanellis J, Watanabe S, Li JH, Kang DH, Li P, Nakagawa T, Wamsley A, Sheikh-Hamad D, Lan HY, Feng L, Johnson RJ. Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2. Hypertension. 2003 Jun 1;41(6):1287-93.
46. Lanaspa MA, Tapia E, Soto V, Sautin Y, Sánchez-Lozada LG. Uric acid and fructose: potential biological mechanisms. InSeminars in nephrology 2011 Sep 1 (Vol. 31, No. 5, pp. 426-432). WB Saunders.
47. Lim JS, Mietus-Snyder M, Valente A, Schwarz JM, Lustig RH. The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome. Nature reviews Gastroenterology & hepatology. 2010 May;7(5):251-64.
48. Gupta A, Gupta V. Metabolic syndrome: what are the risks for humans?. Bioscience trends. 2010 Oct 1;4(5).
2. Xie D, Zhao H, Lu J, He F, Liu W, Yu W, Wang Q, Hisatome I, Yamamoto T, Koyama H, Cheng J. High uric acid induces liver fat accumulation via ROS/JNK/AP-1 signaling. American Journal of Physiology-Endocrinology and Metabolism. 2021 Jun 1;320(6):E1032-43.
3. Lanaspa MA, Sanchez-Lozada LG, Choi YJ, Cicerchi C, Kanbay M, Roncal-Jimenez CA, Ishimoto T, Li N, Marek G, Duranay M, Schreiner G. Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress: potential role in fructose-dependent and-independent fatty liver. Journal of Biological Chemistry. 2012 Nov 23;287(48):40732-44.
4. Barshop NJ, Sirlin CB, Schwimmer JB, Lavine JE. epidemiology, pathogenesis and potential treatments of paediatric non‐alcoholic fatty liver disease. Alimentary pharmacology & therapeutics. 2008 Jul;28(1):13-24.
5. JG F. Epidemiology of non-alcoholic fatty liver disease in China. J Hepatol. 2009;50:204-10.
6. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL, Asia–Pacific Working Party on NAFLD1. How common is non‐alcoholic fatty liver disease in the Asia–Pacific region and are there local differences?. Journal of gastroenterology and hepatology. 2007 Jun;22(6):788-93.
7. Fracanzani AL, Valenti L, Bugianesi E, Andreoletti M, Colli A, Vanni E, Bertelli C, Fatta E, Bignamini D, Marchesini G, Fargion S. Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes. Hepatology. 2008 Sep;48(3):792-8.
8. Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, McCullough AJ, Natale S, Forlani G, Melchionda N. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001 Aug 1;50(8):1844-50.
9. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, Natale S, Vanni E, Villanova N, Melchionda N, Rizzetto M. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003 Apr 1;37(4):917-23.
10. ul Haq A, Mahmood R, Ahmad Z, ur Rehman J, Jilani G. Association of serum uric acid with blood urea and serum creatinine. Pakistan Journal of Physiology. 2010 Dec 31;6(2):46-9.
11. Safi AJ, Mehmood R, Khan MA, ul Haq A. Association of Serum Urinc eAcid with Type II Diabetes Mellitus. Journal of Postgraduate Medical Institute. 2004;18(1).
12. Yoo TW, Sung KC, Shin HS, Kim BJ, Kim BS, Kang JH, Lee MH, Park JR, Kim H, Rhee EJ, Lee WY. Relationship between serum uric acid concentration and insulin resistance and metabolic syndrome. Circulation Journal. 2005;69(8):928-33.
13. Hjortnaes J, Algra A, Olijhoek J, Huisman M, Jacobs J, van der Graaf Y, Visseren F. Serum uric acid levels and risk for vascular diseases in patients with metabolic syndrome. The Journal of rheumatology. 2007 Sep 1;34(9):1882-7.
14. Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. The American journal of medicine. 2007 May 1;120(5):442-7.
15. Li Y, Xu C, Yu C, Xu L, Miao M. Association of serum uric acid level with non-alcoholic fatty liver disease: a cross-sectional study. Journal of hepatology. 2009 May 1;50(5):1029-34.
16. Abbasi S, Haleem N, Jadoon S, Farooq A. Association of non-alcoholic fatty liver disease with serum uric acid. Journal of Ayub Medical College Abbottabad. 2018 Dec 9;31(1):64-6.
17. Modan M, Halkin H, Karasik A, Lusky A. Elevated serum uric acid—a facet of hyperinsulinaemia. Diabetologia. 1987 Sep;30:713-8.
18. Quinones Galvan A, Natali A, Baldi SI, Frascerra SI, Sanna GI, Ciociaro DE, Ferrannini E. Effect of insulin on uric acid excretion in humans. American Journal of Physiology-Endocrinology and Metabolism. 1995 Jan 1;268(1):E1-5.
19. Muscelli E, Natali A, Bianchi S, Bigazzi R, Galvan AQ, Sironi AM, Frascerra S, Ciociaro D, Ferrannini E. Effect of insulin on renal sodium and uric acid handling in essential hypertension. American journal of hypertension. 1996 Aug 1;9(8):746-52.
20. Fruehwald-Schultes B, Peters A, Kern W, Beyer J, Pfützner A. Serum leptin is associated with serum uric acid concentrations in humans. Metabolism. 1999 Jun 1;48(6):677-80.
21. Matsubara M, Chiba H, Maruoka S, Katayose S. Elevated serum leptin concentrations in women with hyperuricemia. Journal of Atherosclerosis and Thrombosis. 2002;9(1):28-34.
22. Rahmouni K, Haynes WG. Endothelial effects of leptin: implications in health and diseases. Current diabetes reports. 2005 Jul;5(4):260-6.
23. Cappuccio FP, Strazzullo P, Farinaro E, Trevisan M. Uric acid metabolism and tubular sodium handling: results from a population-based study. Jama. 1993 Jul 21;270(3):354-9.
24. Nieto FJ, Iribarren C, Gross MD, Comstock GW, Cutler RG. Uric acid and serum antioxidant capacity: a reaction to atherosclerosis?. Atherosclerosis. 2000 Jan 1;148(1):131-9.
25. Waring SW, Webb DJ, Maxwell SR. Systemic uric acid administration increases serum antioxidant capacity in healthy volunteers. Journal of cardiovascular pharmacology. 2001 Sep 1;38(3):365-71.
26. Albano E, Mottaran E, Occhino G, Reale E, Vidali M. role of oxidative stress in the progression of non‐alcoholic steatosis. Alimentary pharmacology & therapeutics. 2005 Nov;22:71-3.
27. García‐Ruiz I, Rodríguez‐Juan C, Díaz‐Sanjuan T, del Hoyo P, Colina F, Muñoz‐Yagüe T, Solís‐Herruzo JA. Uric acid and anti‐TNF antibody improve mitochondrial dysfunction in ob/ob mice. Hepatology. 2006 Sep;44(3):581-91.
28. Hayden MR, Tyagi SC. Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: The urate redox shuttle. Nutrition & metabolism. 2004 Dec;1:1-5.
29. Patterson RA, Horsley ET, Leake DS. Prooxidant and antioxidant properties of human serum ultrafiltrates toward LDL: important role of uric acid. Journal of Lipid Research. 2003 Mar 1;44(3):512-21.
30. Harrison R. Structure and function of xanthine oxidoreductase: where are we now?. Free Radical Biology and Medicine. 2002 Sep 15;33(6):774-97.
31. Berry CE, Hare JM. Xanthine oxidoreductase and cardiovascular disease: molecular mechanisms and pathophysiological implications. The Journal of physiology. 2004 Mar 16;555(3):589-606.
32. Clausen JO, Borch-Johnsen K, Ibsen H, Pedersen O. Analysis of the relationship between fasting serum uric acid and the insulin sensitivity index in a population-based sample of 380 young healthy Caucasians. European journal of endocrinology. 1998 Jan;138(1):63-9.
33. Matsuura F, Yamashita S, Nakamura T, Nishida M, Nozaki S, Funahashi T, Matsuzawa Y. Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism. 1998 Aug 1;47(8):929-33.
34. Chen LY, Zhu WH, Chen ZW, Dai HL, Ren JJ, Chen JH, Chen LQ, Fang LZ. Relationship between hyperuricemia and metabolic syndrome. Journal of Zhejiang University Science B. 2007 Jul;8:593-8.
35. Schmidt MI, Watson RL, Duncan BB, Metcalf P, Brancati FL, Sharrett AR, Davis CE, Heiss G, Atherosclerosis Risk in Communities Study Investigators. Clustering of dyslipidemia, hyperuricemia, diabetes, and hypertension and its association with fasting insulin and central and overall obesity in a general population. Metabolism. 1996 Jun 1;45(6):699-706.
36. Petta S, Cammà C, Cabibi D, Di Marco V, Craxì A. Hyperuricemia is associated with histological liver damage in patients with non‐alcoholic fatty liver disease. Alimentary pharmacology & therapeutics. 2011 Oct;34(7):757-66.
37. Baldwin W, McRae S, Marek G, Wymer D, Pannu V, Baylis C, Johnson RJ, Sautin YY. Hyperuricemia as a mediator of the proinflammatory endocrine imbalance in the adipose tissue in a murine model of the metabolic syndrome. Diabetes. 2011 Apr 1;60(4):1258-69.
38. Hoque R, Vodovotz Y, Mehal W. Therapeutic strategies in inflammasome mediated diseases of the liver. Journal of hepatology. 2013 May 1;58(5):1047-52.
39. Shi Y. Caught red-handed: uric acid is an agent of inflammation. The Journal of clinical investigation. 2010 Jun 1;120(6):1809-11.
40. Kono H, Chen CJ, Ontiveros F, Rock KL. Uric acid promotes an acute inflammatory response to sterile cell death in mice. The Journal of clinical investigation. 2010 Jun 1;120(6):1939-49.
41. Shi Y, Mucsi AD, Ng G. Monosodium urate crystals in inflammation and immunity. Immunological reviews. 2010 Jan;233(1):203-17.
42. Marangella M. Uric acid elimination in the urine. Hyperuricemic syndromes: pathophysiology and therapy. 2005;147:132-48.
43. Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. American Journal of Physiology-Cell Physiology. 2007 Aug;293(2):C584-96.
44. Kang DH, Han L, Ouyang X, Kahn AM, Kanellis J, Li P, Feng L, Nakagawa T, Watanabe S, Hosoyamada M, Endou H. Uric acid causes vascular smooth muscle cell proliferation by entering cells via a functional urate transporter. American journal of nephrology. 2005 Oct 1;25(5):425-33.
45. Kanellis J, Watanabe S, Li JH, Kang DH, Li P, Nakagawa T, Wamsley A, Sheikh-Hamad D, Lan HY, Feng L, Johnson RJ. Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2. Hypertension. 2003 Jun 1;41(6):1287-93.
46. Lanaspa MA, Tapia E, Soto V, Sautin Y, Sánchez-Lozada LG. Uric acid and fructose: potential biological mechanisms. InSeminars in nephrology 2011 Sep 1 (Vol. 31, No. 5, pp. 426-432). WB Saunders.
47. Lim JS, Mietus-Snyder M, Valente A, Schwarz JM, Lustig RH. The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome. Nature reviews Gastroenterology & hepatology. 2010 May;7(5):251-64.
48. Gupta A, Gupta V. Metabolic syndrome: what are the risks for humans?. Bioscience trends. 2010 Oct 1;4(5).
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Feb 19, 2025
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Dr. Pramila Devi R., & Dr. Sohan Channeshappa Kotigera. (2025). THE ASSOCIATION OF SERUM URIC ACID WITH NON-ALCOHOLIC FATTY LIVER DISEASE – A CASE CONTROL STUDY IN A TERTIARY HOSPITAL IN NORTH KARNATAKA. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 1105-1121. https://doi.org/10.53555/pzfda132
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Author Biographies
Dr. Pramila Devi R.
MBBS, MD (General Medicine), Professor, Department of General Medicine, S. Nijalingappa medical college, Navanagar, Bagalkot – 587103, Karnataka, India
Dr. Sohan Channeshappa Kotigera
MBBS, Department of General Medicine, S. Nijalingappa medical college, Navanagar, Bagalkot – 587103, Karnataka, India,
How to Cite
Dr. Pramila Devi R., & Dr. Sohan Channeshappa Kotigera. (2025). THE ASSOCIATION OF SERUM URIC ACID WITH NON-ALCOHOLIC FATTY LIVER DISEASE – A CASE CONTROL STUDY IN A TERTIARY HOSPITAL IN NORTH KARNATAKA. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 1105-1121. https://doi.org/10.53555/pzfda132