Abstract
Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disorder strongly associated with metabolic dysfunction, particularly in elderly populations where it presents with higher prevalence and severity. This study aimed to investigate the association between serum uric acid (SUA) levels and NAFLD in older adults, focusing on the independent effect of hyperuricemia on NAFLD risk. We enrolled 469 individuals aged ≥ 65 years who underwent community health checkups. The exposure variable was baseline SUA levels, while the outcome variable was the occurrence of NAFLD. Covariates included age, sex, BMI, blood pressure, diabetes status, lipids (TC, TG, LDL, HDL), glycemic indices (FPG, HBA1C), and physical activity. Multivariable logistic regression was applied to estimate the independent effect of SUA levels and hyperuricemia on NAFLD. Hyperuricemia was significantly associated with increased NAFLD risk (adjusted OR 2.16, 95% CI 1.28-3.67). Stratified analysis revealed a stronger association in individuals with elevated triglycerides (TG ≥ 2.26 mmol/L, OR 7.07, 95% CI 1.72-29.18). However, the association between SUA as a continuous variable and NAFLD risk was attenuated after adjusting for metabolic factors. Hyperuricemia independently increases NAFLD risk in older adults, particularly in those with elevated triglycerides, suggesting a potential synergistic effect. These findings highlight the importance of incorporating SUA assessments into routine metabolic evaluations and developing targeted interventions to mitigate NAFLD risk.