{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:18:44Z","timestamp":1773004724000,"version":"3.50.1"},"reference-count":60,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T00:00:00Z","timestamp":1642464000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Non-alcoholic fatty liver disease (NAFLD) and serum uric acid (SUA) levels are risk factors for developing cardiovascular disease (CVD). Additionally, previous studies have suggested that high SUA levels increase the risk of having NAFLD. However, no study has investigated the relationship between SUA and CVD risk in NAFLD. This study analyzed the relationship between SUA and CVD in NAFLD. Data for this study used the 2016\u20132018 Korean National Health and Nutrition Examination Survey, which represents the Korean population. A total of 11,160 NAFLD patients were included. Participants with hepatic steatosis index \u2265 30 were considered to have NAFLD. Ten-year CVD risk was estimated using an integer-based Framingham risk score. Estimated 10-year CVD risk \u2265 20% was considered high risk. Multiple logistic regression was conducted to calculate the odds ratios (ORs) associated with SUA level and CVD risk. High CVD risk OR increases by 1.31 (95% CI 1.26\u20131.37) times per 1 mg\/dL of SUA. After adjustment, SUA still had an increased risk (OR 1.44; 95% CI 1.38\u20131.51) of CVD. Compared with the lowest SUA quartile group, the highest quartile group showed a significantly higher risk of having CVD before (OR 2.76; 95% CI 2.34\u20133.25) and after (OR 4.01; 95% CI 3.37\u20134.78) adjustment. SUA is independently associated with CVS risk in NAFLD.<\/jats:p>","DOI":"10.3390\/ijerph19031042","type":"journal-article","created":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T08:09:20Z","timestamp":1642493360000},"page":"1042","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The Association between Serum Uric Acid Levels and 10-Year Cardiovascular Disease Risk in Non-Alcoholic Fatty Liver Disease Patients"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9659-897X","authenticated-orcid":false,"given":"Kiduk","family":"Kim","sequence":"first","affiliation":[{"name":"Eulji College of Medicine, Eulji University, Daejeon 34824, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyoonho","family":"Kang","sequence":"additional","affiliation":[{"name":"Eulji College of Medicine, Eulji University, Daejeon 34824, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyewon","family":"Sheol","sequence":"additional","affiliation":[{"name":"Eulji College of Medicine, Eulji University, Daejeon 34824, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihae","family":"Shin","sequence":"additional","affiliation":[{"name":"Eulji College of Medicine, Eulji University, Daejeon 34824, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youngseo","family":"Sim","sequence":"additional","affiliation":[{"name":"Eulji College of Medicine, Eulji University, Daejeon 34824, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taehoon","family":"Yang","sequence":"additional","affiliation":[{"name":"Eulji College of Medicine, Eulji University, Daejeon 34824, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeongwon","family":"Hwang","sequence":"additional","affiliation":[{"name":"Eulji College of Medicine, Eulji University, Daejeon 34824, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1984-1710","authenticated-orcid":false,"given":"Ju-Mi","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Eulji College of Medicine, Eulji University, Daejeon 34824, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1001\/jama.2015.5370","article-title":"Nonalcoholic fatty liver disease: A systematic review","volume":"313","author":"Rinella","year":"2015","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1038\/nrgastro.2013.171","article-title":"The global NAFLD epidemic","volume":"10","author":"Loomba","year":"2013","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention","volume":"15","author":"Younossi","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4309","DOI":"10.1038\/ncomms5309","article-title":"TM6SF2 rs58542926 influences hepatic fibrosis progression in patients with non-alcoholic fatty liver disease","volume":"5","author":"Liu","year":"2014","journal-title":"Nat. Commun."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1002\/hep.23622","article-title":"Homozygosity for the patatin-like phospholipase-3\/adiponutrin I148M polymorphism influences liver fibrosis in patients with nonalcoholic fatty liver disease","volume":"51","author":"Valenti","year":"2010","journal-title":"Hepatology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1002\/hep.23280","article-title":"Obesity and nonalcoholic fatty liver disease: Biochemical, metabolic, and clinical implications","volume":"51","author":"Fabbrini","year":"2010","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1002\/hep.26672","article-title":"Nonalcoholic fatty liver disease, hepatic insulin resistance, and type 2 diabetes","volume":"59","author":"Birkenfeld","year":"2014","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1053\/jhep.2003.50161","article-title":"Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome","volume":"37","author":"Marchesini","year":"2003","journal-title":"Hepatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.jhep.2008.11.021","article-title":"Association of serum uric acid level with non-alcoholic fatty liver disease: A cross-sectional study","volume":"50","author":"Li","year":"2009","journal-title":"J. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Xu, C., Yu, C., Xu, L., Miao, M., and Li, Y. (2010). High serum uric acid increases the risk for nonalcoholic Fatty liver disease: A prospective observational study. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0011578"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"378","DOI":"10.5009\/gnl.2010.4.3.378","article-title":"Serum uric Acid as a predictor for the development of nonalcoholic Fatty liver disease in apparently healthy subjects: A 5-year retrospective cohort study","volume":"4","author":"Lee","year":"2010","journal-title":"Gut Liver"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.jhep.2014.12.012","article-title":"NAFLD: A multisystem disease","volume":"62","author":"Byrne","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_13","unstructured":"OECD (2015). Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, OECD Health Policy Studies, OECD Publishing."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3a","DOI":"10.1016\/j.amjcard.2009.10.007","article-title":"Cardiovascular disease risk factors: Epidemiology and risk assessment","volume":"105","year":"2010","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1056\/NEJMra0800885","article-title":"Uric acid and cardiovascular risk","volume":"359","author":"Feig","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1038\/nrrheum.2015.91","article-title":"Global epidemiology of gout: Prevalence, incidence and risk factors","volume":"11","author":"Kuo","year":"2015","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1161\/01.STR.0000221716.55088.d4","article-title":"Uric acid is a risk factor for myocardial infarction and stroke: The Rotterdam study","volume":"37","author":"Bos","year":"2006","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1681\/ASN.2008010080","article-title":"Elevated uric acid increases the risk for kidney disease","volume":"19","author":"Obermayr","year":"2008","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.7326\/0003-4819-131-1-199907060-00003","article-title":"Serum uric acid and risk for cardiovascular disease and death: The Framingham Heart Study","volume":"131","author":"Culleton","year":"1999","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.atherosclerosis.2008.05.022","article-title":"Uric acid: A marker of increased cardiovascular risk","volume":"202","author":"Gagliardi","year":"2009","journal-title":"Atherosclerosis"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1002\/art.24164","article-title":"Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: A Chinese cohort study","volume":"61","author":"Chen","year":"2009","journal-title":"Arthritis Rheumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.2337\/dc09-0625","article-title":"Elevated serum uric acid concentrations independently predict cardiovascular mortality in type 2 diabetic patients","volume":"32","author":"Zoppini","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/ije\/dyt228","article-title":"Data resource profile: The Korea National Health and Nutrition Examination Survey (KNHANES)","volume":"43","author":"Kweon","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1056\/NEJMra011775","article-title":"Nonalcoholic fatty liver disease","volume":"346","author":"Angulo","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.dld.2009.08.002","article-title":"Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease","volume":"42","author":"Lee","year":"2010","journal-title":"Dig. Liver Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1161\/CIRCULATIONAHA.107.699579","article-title":"General cardiovascular risk profile for use in primary care: The Framingham Heart Study","volume":"117","author":"Vasan","year":"2008","journal-title":"Circulation"},{"key":"ref_27","unstructured":"(2010). WHO Guidelines Approved by the Guidelines Review Committee. Global Recommendations on Physical Activity for Health, World Health Organization."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1056\/NEJMoa054017","article-title":"Body-Mass index and mortality in Korean men and women","volume":"355","author":"Jee","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/j.1464-5491.2006.01858.x","article-title":"Metabolic syndrome\u2014A new world-wide definition. A Consensus Statement from the International Diabetes Federation","volume":"23","author":"Alberti","year":"2006","journal-title":"Diabet. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"54","DOI":"10.15324\/kjcls.2016.48.2.54","article-title":"The assessment of framingham risk score and 10 Year CHD risk according to application of LDL cholesterol or total cholesterol","volume":"48","author":"Kwon","year":"2016","journal-title":"Korean J. Clin. Lab. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.atherosclerosis.2013.08.023","article-title":"Baseline serum uric acid level as a predictor of cardiovascular disease related mortality and all-cause mortality: A meta-analysis of prospective studies","volume":"231","author":"Zhao","year":"2013","journal-title":"Atherosclerosis"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.ijcard.2007.11.094","article-title":"Serum uric acid is an independent predictor for all major forms of cardiovascular death in 28,613 elderly women: A prospective 21-year follow-up study","volume":"125","author":"Strasak","year":"2008","journal-title":"Int. J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2831","DOI":"10.1681\/ASN.2014070660","article-title":"Uric Acid and Cardiovascular Events: A Mendelian Randomization Study","volume":"26","author":"Kleber","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.amjcard.2012.12.034","article-title":"Association of serum uric acid and cardiovascular disease in healthy adults","volume":"111","author":"Kivity","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1093\/rheumatology\/kem159","article-title":"Association of serum uric acid with cardiovascular disease in rheumatoid arthritis","volume":"46","author":"Panoulas","year":"2007","journal-title":"Rheumatology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1056\/NEJMoa1710895","article-title":"Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout","volume":"378","author":"White","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_37","first-page":"696","article-title":"Mechanism of allopurinol-mediated inhibition of pyrimidine biosynthesis","volume":"78","author":"Beardmore","year":"1971","journal-title":"J. Lab. Clin. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1016\/j.lfs.2004.10.031","article-title":"Selectivity of febuxostat, a novel non-purine inhibitor of xanthine oxidase\/xanthine dehydrogenase","volume":"76","author":"Takano","year":"2005","journal-title":"Life Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0009-2797(00)00203-9","article-title":"Cellular distribution, metabolism and regulation of the xanthine oxidoreductase enzyme system","volume":"129","author":"Pritsos","year":"2000","journal-title":"Chem. Biol. Interact."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"40732","DOI":"10.1074\/jbc.M112.399899","article-title":"Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress: Potential role in fructose-dependent and -independent fatty liver","volume":"287","author":"Lanaspa","year":"2012","journal-title":"J. Biol. Chem."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"8603164","DOI":"10.1155\/2016\/8603164","article-title":"Role of Uric Acid Metabolism-Related Inflammation in the Pathogenesis of Metabolic Syndrome Components Such as Atherosclerosis and Nonalcoholic Steatohepatitis","volume":"2016","author":"Kushiyama","year":"2016","journal-title":"Mediat. Inflamm."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.tem.2008.08.005","article-title":"Insulin resistance, inflammation, and non-alcoholic fatty liver disease","volume":"19","author":"Tilg","year":"2008","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1007\/s00125-008-1135-4","article-title":"Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: Causal effect or epiphenomenon?","volume":"51","author":"Targher","year":"2008","journal-title":"Diabetologia"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.atherosclerosis.2006.08.021","article-title":"Non-Alcoholic fatty liver disease and increased risk of cardiovascular disease","volume":"191","author":"Targher","year":"2007","journal-title":"Atherosclerosis"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/j.1467-789X.2009.00594.x","article-title":"Non-Alcoholic fatty liver disease is associated with cardiovascular disease risk markers","volume":"10","author":"Edens","year":"2009","journal-title":"Obes. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"137","DOI":"10.7326\/0003-4819-126-2-199701150-00008","article-title":"Nonalcoholic steatohepatitis","volume":"126","author":"Sheth","year":"1997","journal-title":"Ann. Intern. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1007\/BF01308607","article-title":"Practice and complications of liver biopsy. Results of a nationwide survey in Switzerland","volume":"38","author":"Froehlich","year":"1993","journal-title":"Dig. Dis. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1002\/hep.25762","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association","volume":"55","author":"Chalasani","year":"2012","journal-title":"Hepatology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1002\/hep.24452","article-title":"Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta-analysis","volume":"54","author":"Hernaez","year":"2011","journal-title":"Hepatology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/j.jhep.2009.09.001","article-title":"Validity of real time ultrasound in the diagnosis of hepatic steatosis: A prospective study","volume":"51","author":"Dasarathy","year":"2009","journal-title":"J. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2935","DOI":"10.1016\/j.jacc.2013.11.005","article-title":"2013 ACC\/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"63","author":"Goff","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.atherosclerosis.2015.07.033","article-title":"The ACC\/AHA 2013 pooled cohort equations compared to a Korean Risk Prediction Model for atherosclerotic cardiovascular disease","volume":"242","author":"Jung","year":"2015","journal-title":"Atherosclerosis"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Chia, Y.C., Lim, H.M., and Ching, S.M. (2014). Validation of the pooled cohort risk score in an Asian population-a retrospective cohort study. BMC Cardiovasc. Disord., 14.","DOI":"10.1186\/1471-2261-14-163"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.ijcard.2014.07.066","article-title":"Comparison of the Framingham Risk Score, SCORE and WHO\/ISH cardiovascular risk prediction models in an Asian population","volume":"176","author":"Selvarajah","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e007324","DOI":"10.1136\/bmjopen-2014-007324","article-title":"Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: A retrospective cohort study","volume":"5","author":"Chia","year":"2015","journal-title":"BMJ Open"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12937-017-0237-6","article-title":"Standardized serum 25-hydroxyvitamin D concentrations are inversely associated with cardiometabolic disease in U.S. adults: A cross-sectional analysis of NHANES, 2001\u20132010","volume":"16","author":"Kimball","year":"2017","journal-title":"Nutr. J."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"F\u00e6rch, K., Bergman, B., and Perreault, L. (2012). Does insulin resistance drive the association between hyperglycemia and cardiovascular risk?. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0039260"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.maturitas.2017.12.002","article-title":"Oxidative stress is increased in sarcopenia and associated with cardiovascular disease risk in sarcopenic obesity","volume":"109","author":"Bellanti","year":"2018","journal-title":"Maturitas"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"264","DOI":"10.3346\/jkms.2015.30.3.264","article-title":"Relationship between sarcopenic obesity and cardiovascular disease risk as estimated by the Framingham risk score","volume":"30","author":"Kim","year":"2015","journal-title":"J. Korean Med. Sci."},{"key":"ref_60","first-page":"366","article-title":"Sarcopenia is associated with Framingham risk score in the Korean population: Korean National Health and Nutrition Examination Survey (KNHANES) 2010\u20132011","volume":"12","author":"Byeon","year":"2015","journal-title":"J. Geriatr. Cardiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1042\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:03:16Z","timestamp":1760133796000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1042"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,18]]},"references-count":60,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["ijerph19031042"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19031042","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,18]]}}}