Circulating uric acid is independently associated with MASLD prevalence and non-invasive advanced fibrosis risk stratification in a Caucasian T2DM cohort

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Metabolic dysfunction-associated steatotic liver disease (MASLD) is a primary cause of chronic liver disease, affecting over half of individuals with Type 2 Diabetes Mellitus (T2DM). Although uric acid (UA) is linked to metabolic risk factors, its independent association with MASLD presence and advanced liver fibrosis risk within European T2DM populations remains to be fully clarified. This study investigated the relationship between serum UA levels, MASLD prevalence and non-invasive advanced fibrosis risk strata. We cross-sectionally evaluated 768 Caucasian T2DM patients (473 males and 295 females) from the Catanzaro Metabolic Risk Factors Study (CATAMERIS). MASLD was diagnosed via standardized ultrasonography (n = 522). Advanced liver fibrosis risk was stratified using the age-adjusted FIB-4 index into low risk (Grade 0), indeterminate risk (Grade 1), and high risk (Grade 2). Multivariable logistic regression analyses and a stringent sensitivity model adjusting for all major concomitant medications (glucose-lowering, lipid-lowering, and antihypertensive regimens) were performed. The MASLD group exhibited significantly higher UA, BMI, lipid profiles, and HbA1c levels. Across the fibrosis strata (Grade 0 to Grade 2), a stepwise upward trend in serum UA was observed (5.6 ± 1.5 vs. 6.0 ± 1.6 vs. 6.1 ± 1.7 mg/dL; univariable p = 0.067). In the final fully adjusted models, after accounting for demographic, metabolic and therapeutic covariates, elevated serum UA remained robustly and independently associated with an increased likelihood of both MASLD (OR = 1.565, 95% CI = 1.079-2.270, p = 0.018) and high advanced liver fibrosis risk (Grade 2) (OR = 1.344, 95% CI = 1.056-1.710, p = 0.016). These findings demonstrate that serum UA is strongly snd independently associated with MASLD prevalence and high advanced fibrosis risk in patients with T2DM, suggesting its utility as a reliable, non-redundant biomarker for stratified metabolic liver evaluation.

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