Hyperuricemia—Especially “Metabolic Hyperuricemia”—Is Independently Associated with a Higher Risk of Steatotic Liver Disease

<b>Background</b>: Hyperuricemia and steatotic liver disease are both associated with various comorbidities and mortality. This study was carried out to study the association between hyperuricemia and steatotic liver disease and to assess the impact of the etiology of hyperuricemia on the development of steatotic liver disease. <b>Methods</b>: Data from a population-based study of 2635 individuals aged 52-76 years was used. Hyperuricemia was defined as a serum urate (SU) of >410 μmol/L (≈6.9 mg/dL; 75th percentile) and steatotic liver disease as a fatty liver index (FLI) of ≥80 (75th percentile). We defined hyperuricemia as renal if estimated glomerular filtration rate (eGFR) was ≤67 mL/min/1.73 m² (25th percentile) and as metabolic if eGFR was >67 mL/min/1.73 m². <b>Results</b>: FLI correlated with SU in women [r = 0.47 (95% CI: 0.43 to 0.51)] and men [r = 0.37 (95% CI: 0.32 to 0.42)]. Compared to those with SU ≤ 410 μmol/L and FLI < 80, the hazard ratio (HR) for all-cause mortality was 1.76 (95% CI: 1.39 to 2.23) in hyperuricemic individuals with FLI ≥ 80, 1.16 (95% CI: 0.95 to 1.40) in hyperuricemic individuals with FLI < 80, and 1.34 (95% CI: 1.06 to 1.70) in persons with SU ≤ 410 μmol/L and FLI ≥ 80. Individuals with metabolic hyperuricemia had a statistically significantly higher FLI than individuals with renal hyperuricemia: mean (SD) = 73.4 (12.2) and 69.6 (22.5), respectively, <i>p</i> = 0.015 after adjusting for sex and diabetes. <b>Conclusions</b>: FLI correlates positively with SU, and it is higher in persons with metabolic hyperuricemia. Both steatotic liver disease and hyperuricemia increase mortality.