1
|
Huang X, Chen X, Liu Q, Zhang Z, Miao J, Lai Y, Wu J. The relationship between education attainment and gout, and the mediating role of modifiable risk factors: a Mendelian randomization study. Front Public Health 2024; 11:1269426. [PMID: 38259784 PMCID: PMC10800502 DOI: 10.3389/fpubh.2023.1269426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Objective To investigate the causal relationship between educational attainment (EA) and gout, as well as the potential mediating effects of individual physical status (IPS) such as body mass index (BMI) and systolic blood pressure (SBP) and lifestyle habits (LH) including alcohol intake frequency (drinking), current tobacco smoking (smoking), and time spent watching television (TV). Methods Utilizing two-sample Mendelian randomization (MR), we analyzed the causal effects of EA on gout risk, and of IPS (BMI and SBP) and LH (smoking, drinking, and TV time) on gout risk. Multivariable MR (MVMR) was employed to explore and quantify the mediating effects of IPS and LH on the causal relationship between EA and gout risk. Results An elevation of educational attainment by one standard deviation (4.2 years) exhibited a protective effect against gout (odds ratio 0.724, 95% confidence interval 0.552-0.950; p = 0.020). We did not observe a causal relationship between smoking and gout, but BMI, SBP, drinking, and TV time were found to be causal risk factors for gout. Moreover, BMI, SBP, drinking, and TV time acted as mediating factors in the causal relationship between EA and gout risk, explaining 27.17, 14.83, 51.33, and 1.10% of the causal effects, respectively. Conclusion Our study indicates that having a genetically predicted higher level of EA may provide protection against gout. We found that this relationship is influenced by IPS factors such as BMI and SBP, as well as LH including drinking and TV time.
Collapse
Affiliation(s)
- Xin Huang
- Department of Orthopedics, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, China
| | - Xin Chen
- Department of Urology, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, China
| | - Qixi Liu
- Department of Nursing, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, China
| | - Zhiwei Zhang
- Department of Orthopedics, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, China
| | - Juan Miao
- Department of Nursing, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, China
| | - Yuchan Lai
- Department of Nursing, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, China
| | - Jinqing Wu
- Department of Orthopedics, Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, China
| |
Collapse
|
2
|
Sun K, Ming Y, Wu Y, Zeng Y, Xu J, Wu L, Li M, Shen B. The Genetic Causal Association between Educational Attainment and Risk of 12 Common Musculoskeletal Disorders: A Two-Sample Mendelian Randomization. Orthop Surg 2023; 15:2814-2821. [PMID: 37675772 PMCID: PMC10622299 DOI: 10.1111/os.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE In numerous observational studies, there has been an indication that educational attainment (EA) can impact the intensity of pain and disability resulting from chronic musculoskeletal disorders. Nonetheless, the association observed in these studies is not entirely conclusive. The aim of this study was to investigate the genetic causal relationship between educational attainment and 12 musculoskeletal disorders using Mendelian randomization (MR). METHODS The meta-analysis of genome-wide association studies (GWAS) identified 3952 single-nucleotide polymorphisms (SNPs) associated with educational attainment (EA) from the Social Science Genetic Association Consortium (SSGAC). Genetic data for 12 musculoskeletal disorders, including osteonecrosis, osteoporosis, osteomyelitis, low back pain, gout, spinal stenosis, rheumatoid arthritis, meniscus derangement, rotator cuff syndrome, ankylosing spondylitis, cervicobrachial syndrome, and lateral epicondylitis, were obtained from the FinnGen consortium. We conducted a two-sample Mendelian randomization analysis to examine the causal effect of EA on the risk of these musculoskeletal disorders using the TwoSampleMR package in R. RESULTS Based on the inverse-variance weighted (IVW) method, we found that a genetically predicted per standard deviation (SD) increase in EA was inversely associated with low back pain [odds ratio (OR) 0.46, 95% confidence interval (Cl) 0.51-0.61, p < 0.001], spinal stenosis (OR 0.62, 95% Cl 0.54-0.71, p < 0.001), rheumatoid arthritis (OR 0.65, 95% Cl 0.55-0.76, p < 0.001), meniscus derangement (OR 0.73, 95% Cl 0.65-0.82, p < 0.001), rotator cuff syndrome (OR 0.55, 95% Cl 0.49-0.61, p < 0.001), cervicobrachial syndrome (OR 0.50, 95% Cl 0.42-0.60, p < 0.001), and lateral epicondylitis (OR 0.30, 95% Cl 0.24-0.37, p < 0.001). There was no causal association between EA and osteonecrosis (OR 1.11, 95% CI 0.76-1.72, p = 0.60), osteoporosis (OR 0.91, 95% CI 0.65-1.27, p = 0.59), or osteomyelitis (OR 0.90, 95% CI 0.75-1.01, p = 0.22). Genetic predisposition to EA had a suggestive causal association with gout (OR 0.80, 95% CI 0.68-0.95, p = 0.01) and ankylosing spondylitis (OR 0.64, 95% CI 0.45-0.91, p = 0.01) after Bonferroni correction. None of the analyses revealed any horizontal pleiotropy or heterogeneity. CONCLUSION In our investigation, we have uncovered evidence supporting a causal relationship between low level of EA and the incidence of certain musculoskeletal disorders. In the future, it is imperative to ascertain risk factors such as lifestyle patterns linked with EA to uncover the underlying causal relationship and offer informed interventions for individuals.
Collapse
Affiliation(s)
- Kaibo Sun
- Department of Orthopaedics Surgery, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Yue Ming
- Laboratory of Molecular Oncology, Frontiers Science Center for Disease‐related Molecular NetworksWest China Hospital, Sichuan UniversityChengduChina
| | - Yuangang Wu
- Department of Orthopaedics Surgery, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Yi Zeng
- Department of Orthopaedics Surgery, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Jiawen Xu
- Department of Orthopaedics Surgery, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Limin Wu
- Department of Orthopaedics Surgery, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Mingyang Li
- Department of Orthopaedics Surgery, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Bin Shen
- Department of Orthopaedics Surgery, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| |
Collapse
|
3
|
Oka P, Chong WM, Ng DX, Aau WK, Tan NC. Epidemiology and risk factors associated with gout control among adult Asians: a real-world retrospective cohort study. Front Med (Lausanne) 2023; 10:1253839. [PMID: 37746085 PMCID: PMC10513174 DOI: 10.3389/fmed.2023.1253839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Background Gout is associated with significant morbidity and mortality, yet suboptimal gout control remains a problem globally. Identifying the risk factors associated with poor gout control among patients in primary care allows targeted interventions to improve their clinical management. This study aimed to determine the prevalence of poor gout control and its associated demographic and clinical factors among urbanized community-dwelling Asian patients. Methods This retrospective study was based on data extracted from the electronic medical records of 8 public primary care clinics in Singapore. Patients with a diagnostic code of gout who had 2 or more visits between 1st January 2018 and 31st December 2019 were included in the analysis. Data extracted included: demographics, anthropological measurements, comorbidities, serum uric acid levels and medication prescription. A patient is defined to have poor gout control if they suffer two or more acute gout attacks within a year. Chi-Squared test was used for categorical parameters. For continuous variables, univariate logistic regression analysis was first performed. Significant factors (p ≤ 0.1) were then included in the logistics regression model to account for confounders. Results A total of 7,970 patients and 24,624 visits were included in the analysis. The prevalence of poorly controlled gout was 28.2% (n = 2,244/7,970); only 46.3% of them (n = 1,039/2,244) were prescribed allopurinol and 13.4% (n = 301/2,244) were taking doses ≥300 mg. Using logistic regression, factors associated with poor gout control were: male gender [adjusted OR (AOR) =1.66, p < 0.001], Malay ethnicity (AOR = 1.27, p = 0.007), congestive heart failure (AOR = 1.64, p = 0.037). Patients prescribed allopurinol (AOR = 1.52, p < 0.001), NSAIDs (AOR = 2.76, p < 0.001) and corticosteroids (AOR = 2.83, p < 0.001) were more likely to have poorly-controlled gout. Conclusion Nearly 30% of patients had poor gout. Interventions should focus on male and Malay patients and those with congestive cardiac failure.
Collapse
Affiliation(s)
- Prawira Oka
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | | | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| |
Collapse
|
4
|
Brooks J, Montgomery A, Dalbeth N, Sapsford M, Ngan Kee R, Cooper A, Quincey V, Bhana S, Gore-Massy M, Hausmann J, Liew J, Machado PM, Sufka P, Sirotich E, Robinson P, Wallace Z, Yazdany J, Grainger R. Omicron variant infection in inflammatory rheumatological conditions - outcomes from a COVID-19 naive population in Aotearoa New Zealand. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100843. [PMID: 37520279 PMCID: PMC10372177 DOI: 10.1016/j.lanwpc.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023]
Abstract
Background Due to geographic isolation and border controls Aotearoa New Zealand (AoNZ) attained high levels of population coronavirus disease-19 (COVID-19) vaccination before widespread transmission of COVID-19. We describe outcomes of SARS-CoV-2 infection (Omicron variant) in people with inflammatory rheumatic diseases in this unique setting. Methods This observational study included people with inflammatory rheumatic disease and SARS-CoV-2 infection in AoNZ between 1 February and 30 April 2022. Data were collected via the Global Rheumatology Alliance Registry including demographic and rheumatic disease characteristics, and COVID-19 vaccination status and outcomes. Multivariable logistic regression was used to explore associations of demographic and clinical factors with COVID-19 hospitalisation and death. Findings Of the 1599 cases included, 96% were from three hospitals that systematically identified people with inflammatory rheumatic disease and COVID-19. At time of COVID-19, 1513 cases (94.6%) had received at least two COVID-19 vaccinations. Hospitalisation occurred for 104 (6.5%) cases and 10 (0.6%) patients died. Lower frequency of hospitalisation was seen in cases who had received at least two vaccinations (5.9%), compared to the unvaccinated (20.6%) or those with a single vaccine dose (10.7%). In multivariable adjusted models, people with gout or connective tissue diseases (CTD) had increased risk of the combined outcome of hospitalisation/death, compared to people with inflammatory arthritis. Glucocorticoid and rituximab use were associated with increased rates of hospitalisation/death. All patients who died had three or more co-morbidities or were over 60 years old. Interpretation In this cohort with inflammatory rheumatic diseases and high vaccination rates, severe outcomes from SARS-CoV-2 Omicron variant were relatively infrequent. The outcome of Omicron variant infection among vaccinated but SARS-CoV-2 infection-naive people with inflammatory rheumatic disease without other known risk factors were favourable. Funding Financial support from the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) included management of COVID-19 Global Rheumatology Alliance funds.
Collapse
Affiliation(s)
- Jonathon Brooks
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Anna Montgomery
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, New Zealand
| | - Mark Sapsford
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Rachel Ngan Kee
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Amy Cooper
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Vicki Quincey
- Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | | | | | - Jonathan Hausmann
- Program in Rheumatology, Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pedro M. Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | | | - Philip Robinson
- University of Queensland School of Clinical Medicine, Herston, Queensland, Australia
- Department of Rheumatology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Zachary Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, New Zealand
- Te Whatu Ora Health New Zealand Capital Coast and Hutt, Wellington, New Zealand
| |
Collapse
|
5
|
Zhang J, Jin C, Ma B, Sun H, Chen Y, Zhong Y, Han C, Liu T, Li Y. Global, regional and national burdens of gout in the young population from 1990 to 2019: a population-based study. RMD Open 2023; 9:rmdopen-2023-003025. [PMID: 37094981 PMCID: PMC10152042 DOI: 10.1136/rmdopen-2023-003025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/02/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE To use data from the Global Burden of Disease (GBD) Study 2019 to report the global, regional and national rates and trends of annual incidence, point prevalence and years lived with disability (YLD) for gout in adolescents and young adults aged 15-39 years. METHODS We conducted a serial cross-sectional study of gout burden in the young population aged 15-39 years using data from GBD Study 2019. We extracted rates per 100 000 population of incidence, prevalence and YLD of gout, then calculated their average annual percentage changes (AAPCs) at the global, regional and national level between 1990 and 2019 by sociodemographic index (SDI). RESULTS The global gout prevalent cases in individuals aged 15-39 years was 5.21 million in 2019, with the annual incidence substantially increasing from 38.71 to 45.94 per 100 000 population during 1990-2019 (AAPC 0.61, 95% CI 0.57 to 0.65). This substantial increase was observed in all SDI quintiles (low, low-middle, middle, high-middle and high) and every age subgroup (15-19, 20-24, 25-29, 30-34 and 35-39 years). Males accounted for 80% of the gout burden. High-income North America and East Asia were facing a substantial increase in gout incidence and YLD simultaneously. Elimination of high body mass index can reduce 31.74% of the gout YLD globally in 2019, which varied from 6.97% to 59.31% regionally and nationally. CONCLUSION Gout incidence and YLD in the young population grew simultaneously and substantially in both developed and developing countries. Improving representative national-level data on gout, interventions for obesity and awareness in young populations are strongly suggested.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Health Science Center, Shenzhen University, Shenzhen, China
| | - Chenye Jin
- Department of Rheumatology and Immunology, The First Hospital of China Medical University, Shenyang, China
| | - Bing Ma
- Department of Clinical Epidemiology and Evidence-based Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Hao Sun
- Department of Clinical Epidemiology and Evidence-based Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Yanmei Chen
- School of Mathematics and Systems Science, Guangdong Polytechnic Normal University, Guangzhou, China
| | - Ying Zhong
- Department of Pediatrics, Shenzhen United Family Hospital, Shenzhen, China
| | - Cheng Han
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Tingting Liu
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yongze Li
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| |
Collapse
|
6
|
Santacroce L, Dellaripa PF, Costenbader KH, Collins J, Feldman CH. Association of Area-Level Heat and Social Vulnerability With Recurrent Hospitalizations Among Individuals With Rheumatic Conditions. Arthritis Care Res (Hoboken) 2023; 75:22-33. [PMID: 36071609 PMCID: PMC9947700 DOI: 10.1002/acr.25015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Climate and social vulnerability contribute to morbidity and health care utilization. We examined associations between the neighborhood Social Vulnerability Index (SVI) and the Heat Vulnerability Index (HVI) and recurrent hospitalizations among individuals with rheumatic conditions. METHODS Using a Massachusetts multihospital centralized clinical data repository, we identified individuals ≥18 years of age with a rheumatic condition who received rheumatology care within 3 years of April 2021. We defined the index date as 2 years before the last encounter and the baseline period as 1 year pre-index date. Addresses were geocoded and linked by census tract to the SVI and the HVI. We used multilevel, multinomial logistic regression to examine the odds of 1-3 and ≥4 hospitalizations (reference = 0) over 2 years post index date by vulnerability index, adjusting for age, gender, race/ethnicity, insurance, and comorbidities. RESULTS Among 14,401 individuals with rheumatic conditions, the mean ± age was 61.9 ± 15.7 years, 70% were female, 79% White, 7% Black, and 2% Hispanic. There were 8,251 hospitalizations; 11,649 individuals (81%) had 0 hospitalizations, 2,063 (14%) had 1-3, and 689 (5%) had ≥4. Adjusting for individual-level factors, individuals living in the highest versus lowest SVI areas had 1.84 times higher odds (95% confidence interval [95% CI] 1.43-2.36) of ≥4 hospitalizations. Individuals living in the highest versus lowest HVI areas had 1.64 times greater odds (95% CI 1.17-2.31) of ≥4 hospitalizations. CONCLUSION Individuals with rheumatic conditions living in areas with high versus low social and heat vulnerability had significantly greater odds of recurrent hospitalizations. Studies are needed to determine modifiable factors to mitigate risks.
Collapse
Affiliation(s)
- Leah Santacroce
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Paul F. Dellaripa
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Karen H. Costenbader
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Jamie Collins
- OrACORe, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| |
Collapse
|
7
|
Atkins N, Mukhida K. The relationship between patients’ income and education and their access to pharmacological chronic pain management: A scoping review. Can J Pain 2022; 6:142-170. [PMID: 36092247 PMCID: PMC9450907 DOI: 10.1080/24740527.2022.2104699] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nicole Atkins
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karim Mukhida
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
8
|
Nie J, Deng MG, Wang K, Liu F, Xu H, Feng Q, Li X, Yang Y, Zhang R, Wang S. Higher HEI-2015 scores are associated with lower risk of gout and hyperuricemia: Results from the national health and nutrition examination survey 2007-2016. Front Nutr 2022; 9:921550. [PMID: 35990332 PMCID: PMC9381708 DOI: 10.3389/fnut.2022.921550] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Gout, the most prevalent inflammatory arthritis, is becoming increasingly prevalent in the United States and across the world, and it adversely impacts people’s quality of life and their health. Few studies have focused on the relationship between daily dietary quality and gout, so the topic requires further exploration. Data were derived from the National Health and Nutrition Examination Survey 2007–2016, and the inclusion criteria of the analytic sample were (1) adults, age ≥20 years, with complete information about HEI-2015, gout, and uric acid; (2) complete information of demographics, lifestyle (BMI, smoking, drinking), and disease history [hypertension, chronic kidney disease (CKD), diabetes]. The quality of the daily diet was reflected using the Healthy Eating Index 2015 (HEI-2015). The baseline features of different groups were examined using the Scott-Rao chi-square tests, and the association between the HEI-2015 score and the risk of gout/hyperuricemia (HUA) was investigated using weighted logistic regression models. The effects of different dietary components in the HEI-2015 on reducing the risk of gout/HUA were evaluated by weighted quantile sum (WQS) regression models. After adjusting for demographic characteristics, behavioral covariates, and disease history, higher HEI-2015 scores were associated with a significantly lower risk of gout (OR: 0.878, 95% CI: 0.876–0.880) and HUA (OR: 0.978, 95% CI: 0.976–0.979) in weighted logistic regression. Dairy, whole grains, plant proteins, and added sugar contributed greatly in HEI-2015 to reducing gout risk (weights of WQS index: 42, 17.18, 16.13, and 7.93%, respectively). Dairy, total fruits, greens and beans, and plant proteins contributed greatly in HEI-2015 to reducing HUA risk (weights of WQS index: 28.9, 17.13, 16.84, and 11.39%, respectively). As the result, adherence to the American Dietary Guidelines may assist to decrease the risk of gout/HUA in American adults, and greater emphasis should be placed on dairy products, whole grains, fruits, legumes, and added sugars.
Collapse
Affiliation(s)
- Jiaqi Nie
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Kai Wang
- School of Public Health, Wuhan University, Wuhan, China
| | - Fang Liu
- School of Public Health, Wuhan University, Wuhan, China
| | - Haoling Xu
- School of Public Health, Wuhan University, Wuhan, China
| | - Qianqian Feng
- School of Public Health, Wuhan University, Wuhan, China
| | - Xiaosong Li
- School of Public Health, Wuhan University, Wuhan, China
| | - Yichi Yang
- School of Public Health, Wuhan University, Wuhan, China
| | - Ruyi Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Suqing Wang
- School of Public Health, Wuhan University, Wuhan, China.,School of Nursing, Wuhan University, Wuhan, China.,Center for Chronic Disease Rehabilitation, School of Nursing, Wuhan University, Wuhan, China
| |
Collapse
|
9
|
Sandoval-Plata G, Nakafero G, Chakravorty M, Morgan K, Abhishek A. Association between serum urate, gout and comorbidities: a case-control study using data from the UK Biobank. Rheumatology (Oxford) 2021; 60:3243-3251. [PMID: 33313843 DOI: 10.1093/rheumatology/keaa773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/13/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To examine the association between comorbidities and serum urate (SU), gout and comorbidities, and to determine whether the association between gout and comorbidities is independent of SU. METHODS We performed a case-control study using UK Biobank data. Two separate analyses were conducted: one excluding participants with gout to investigate the association between comorbidities and SU and the other with participants with gout as the index condition to examine the association between gout and comorbidities. SU was measured at the baseline visit. Self-reported physician-diagnosed illnesses were used to define gout and comorbidities, except for chronic kidney disease (CKD), which was defined using an estimated glomerular filtration rate cut-off. Participants prescribed urate-lowering treatment were also classified as gout. Logistic regression was used to examine associations. Odds ratios (ORs) and 95% CIs were calculated and adjusted for covariates including comorbidities and SU. RESULTS Data for 458 781 UK Biobank participants were used to examine the association between comorbidities and SU. There was an association between hypertension, ischaemic heart disease (IHD), congestive cardiac failure (CCF), hyperlipidaemia, CKD and SU with and adjusted OR (aOR) of 1.10-3.14 for each 1 mg/dl SU increase. A total of 10 265 gout cases and 458 781 controls were included in the analysis of association between gout and comorbidities. Gout associated independently with hypertension, IHD, CCF, hyperlipidaemia and diabetes, with aORs of 1.21-4.15 after adjusting for covariates including SU. CONCLUSION Comorbidities associate with increasing SU. The association between gout and cardiometabolic comorbidities was independent of SU, suggesting separate SU-independent mechanisms such as inflammation driven by crystal deposition, pro-inflammatory genotype or non-purine dietary factors.
Collapse
Affiliation(s)
- Gabriela Sandoval-Plata
- Academic Rheumatology, University of Nottingham, Nottingham, UK.,Nottingham National Institute for Health Research Biomedical Research Centre, Nottingham, UK.,Human Genetics, School of Life Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Kevin Morgan
- Human Genetics, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Abhishek Abhishek
- Academic Rheumatology, University of Nottingham, Nottingham, UK.,Nottingham National Institute for Health Research Biomedical Research Centre, Nottingham, UK
| |
Collapse
|
10
|
Abstract
Gout, a debilitating inflammatory arthritis, currently affects more than 9 million Americans. Hyperuricemia, the laboratory abnormality associated with the development of gout, also occurs in a significant number of patients with chronic kidney disease (CKD), a condition that affects approximately 14% of the US population. Several recent studies have attempted to provide a definitive link between the presence of hyperuricemia and progression of CKD; however, the treatment of asymptomatic hyperuricemia in CKD is not supported by recent randomized controlled trials. The pharmacology of acute gout flares and urate lowering is complicated in patients who also have evidence of CKD, primarily because of an increased risk of medication toxicity. Recipients of kidney transplants are particularly at risk of debilitating gout and medication toxicity. We review the available data linking CKD, gout, and hyperuricemia, providing practice guidelines on managing gout in CKD patients and kidney transplant recipients. We advocate for much greater involvement of nephrologists in the management of gout in renal patients.
Collapse
Affiliation(s)
| | - David B Mount
- Renal Division, Brigham and Women's Hospital, Boston, MA; Renal Division, VA Boston Healthcare System, Harvard Medical School, Boston, MA.
| |
Collapse
|
11
|
Latent Class Growth Analysis of Gout Flare Trajectories: A Three‐Year Prospective Cohort Study in Primary Care. Arthritis Rheumatol 2020; 72:1928-1935. [DOI: 10.1002/art.41476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 07/30/2020] [Indexed: 01/22/2023]
|
12
|
Better outcomes for patients with gout. Inflammopharmacology 2020; 28:1395-1400. [PMID: 32095979 DOI: 10.1007/s10787-020-00694-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/11/2020] [Indexed: 12/27/2022]
Abstract
Gout is increasing in prevalence despite effective pharmacotherapies. Barriers to effective management are largely educational deficiencies. Sufferers, usually men, need to understand more about gout, especially that maintaining serum urate below 0.36 mmol/L will eliminate recurrent attacks. Also, of great importance is appreciating that sub-optimal adherence to urate-lowering therapy (ULT) will result in a return of attacks. Prescribers also need to understand that acute attacks are likely to occur in the first few months of urate-lowering therapy (ULT), but these can be mitigated by commencing with a dose of ULT reflective of renal function and escalating the dose slowly, every 2-5 weeks until target serum urate is achieved. Prophylaxis against acute attacks over the initial 6 months period of ULT can be enhanced further with concomitant colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs).Gout is largely managed in primary care. Rates of adherence to ULT are 50% or less, worse than most other chronic illnesses. Efforts at educating primary care physicians to, firstly, manage gout effectively and, secondly, to educate their gout patients sufficiently have not been successful. Allied health practitioners, such as nurses, working with prescribers in primary care settings and given the mandate to educate and manage patients with gout, have been spectacularly effective. However, this approach is resource intensive. 'Personalised' eHealth interventions show promise as an alternative strategy, notably in improving adherence to ULT.Numerous applications for smart phones (apps) are now available to assist people with chronic health conditions. Their design needs to accommodate the barriers and enablers perceived by patients to maintaining adherence to prescribed therapies. Personalised feedback of serum urate may represent an important enabler of adherence to ULT in the case of gout.Harnessing mobile apps to support patients managing their chronic illnesses represents an important opportunity to enhance health outcomes. Rigorous, patient-centred and driven development is critical. These tools also require careful evaluation for effectiveness.
Collapse
|