Prevalence and characteristics of metabolic syndrome in gout patients in a hospital setting in sub-Saharan Africa

Natural polysaccharides in the prevention of hyperuricemia: Source, classification, mechanism, application in food industry

Hyperuricemia (HUA) is one of the major threats to human health. In recent years, with the gradual increase in the incidence rate of Hua, the prevention and treatment of HUA has attracted more and more attention. Clinical pharmaceutical interventions, such as Allopurinol, Febuxostat, and so on, though effective, are usually accompanied by notable adverse effects. Therefore, alternative therapy with high-safety natural components has received more and more attention from scholars. The natural polysaccharides showed a significant potential in HUA therapy and more and more natural polysaccharides for treating HUA were being obtained. Therefore, in this review, the recent progress on natural polysaccharides in preventing HUA was presented focusing on the sources, classification, and biological activities (oxidative stress, anti-inflammatory, and UA-lowering) of natural polysaccharides. Furthermore, this review explores the mechanisms of action and application. It is beneficial to the development of polysaccharides for natural HUA therapy and the results of this review could offer guidance on preventing the occurrence of HUA in daily life.

Gout: global epidemiology, risk factors, comorbidities and complications: a narrative review

BACKGROUND

Gout is one of the oldest known diseases and the most common form of inflammatory arthritis. The established risk factors for gout include hyperuricemia, chronic renal disease, genetic, alcohol consumption, dietary factors, diuretic use, hypertension, obesity, and metabolic syndrome. Patients with gout have an increased risk of all-cause mortality, particularly from cardiovascular disease, cancer, and infectious diseases. Gout is also associated with several complications, such as nephrolithiasis. This literature review describes the global epidemiology and trends associated with gout, before providing an overview of its risk factors and complications.

METHODS

This research used the narrative review method. Thorough searches were performed in PubMed and Google scholar, up to June 15, 2024, for articles that evaluated the risk factors, comorbidities or complications associated with gout. Moreover, we also included studies that reported the epidemiological characteristics or burden of gout at the global, regional, or national level.

RESULTS

Gout is more prevalent in developed countries, than in developing countries, although its prevalence is increasing globally. In addition, gout is much more prevalent among males than among females. Hyperuricemia has the largest role in the development of gout, although many risk factors contribute to the increasing prevalence of gout, including genes, several medications, and diet. Gout is associated with several comorbidities and complications, which need to be taken into consideration when managing gout. In recent years, gout has been found to be associated with several new comorbidities.

CONCLUSIONS

Our findings provide a comprehensive and informative overview that can be useful for the prevention, diagnosis, and management of gout.

Impact of Imperata Cylindrica polysaccharide on liver lipid metabolism disorders caused by hyperuricemia

Elevated uric acid levels are associated with lipid metabolism disorders. The effects of Imperata cylindrica polysaccharide (ICPC-a) were explored using a hyperuricemia mouse model and a uric acid-induced HepG2 hepatocyte model. ICPC-a significantly improved total cholesterol, triglycerides, low-density lipoprotein levels, and hepatic lipid deposition in hyperuricemia mice. The liver/body weight ratio decreased, and markers of liver damage, inflammation, and dyslipidemia improved. Metabolomics analysis suggested that ICPC-a modulates lipid metabolism by influencing the glycerophospholipid pathway and the enzyme LPCAT3. Stable HepG2 cell lines with knocked-down LPCAT3 were constructed, and western blot and RT-PCR were used to assess the impact of its knockdown on lipid metabolism under uric acid stimulation. In cells with reduced LPCAT3 expression, ICPC-a was still able to alleviate uric acid-induced lipid accumulation, though the effect was less pronounced compared to cells with normal LPCAT3 levels. However, the effectiveness was diminished compared to cells where LPCAT3 was not knocked down. These findings indicated that LPCAT3 was an important target through which ICPC-a regulated lipid metabolism disorders induced by hyperuricemia. These discoveries emphasized that ICPC-a, as a prebiotic, could modulate hepatic lipid accumulation and inflammation, contributing to the maintenance of hepatic lipid homeostasis.

Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis

BACKGROUND

The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations.

METHODS

A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study.

RESULTS

In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6).

CONCLUSION

This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.

Rheumatic diseases in Africa

Historically, rheumatic diseases have not received much attention in Africa, particularly in sub-Saharan Africa, possibly owing to a focus on the overwhelming incidence of infectious diseases and the decreased life span of the general population in this region. Global attention and support, together with better health policies and planning, have improved outcomes for many infectious diseases; thus, increasing attention is being turned to chronic non-communicable diseases. Rheumatic diseases were previously considered to be rare among Africans but there is now a growing interest in these conditions, particularly as the number of rheumatologists on the continent increases. This interest has resulted in a growing number of publications from Africa on the more commonly encountered rheumatic diseases, as well as case reports of rare diseases. Despite the limited amount of available data, some aspects of the epidemiology, genetics and clinical and laboratory features of rheumatic diseases in African populations are known, as is some detail on the use of therapeutics. Similarities and differences in these conditions can be seen across the multi-ethnic and genetically diverse African continent, and it is hoped that increased awareness of rheumatic diseases in Africa will lead to earlier diagnosis and better outcomes for patients.

The prevalence of rheumatic diseases is increasing in African countries, leading to an increased need for specialist rheumatologists and disease-modifying drugs. In this Review, the authors outline what is currently known about the state of rheumatic diseases in Africa.

In the past, there has been an emphasis on communicable diseases in Africa, but attention has now shifted towards non-communicable diseases such as rheumatic diseases.

Common rheumatic diseases are seen in Africa and are both comparable and different from presentations seen outside of Africa.

Diverse genetic and environmental factors affect the presentation of common rheumatic diseases among different African nations.

A shortage of appropriately trained staff, laboratory testing capacity and effective medications exists across the whole continent.

Advocacy and research are needed to increase awareness of the risk factors, presentations and management of rheumatic diseases in Africa.

Specialized treatment guidelines are needed for resource-poor countries in Africa.

The management of gout in Africa: challenges and opportunities

The rise in non-communicable diseases in Africa presents challenges for health systems that are burdened by infectious diseases. Gout is one of those diseases that has seen an increase in numbers worldwide, including Africa. Gout is commonly associated with comorbidities and mortality. It directly impacts the quality of life, increases health costs, decreases physical function, and significantly increases the time from work, much of which is potentially avoided if treatment is instituted early. Despite advances in understanding the pathophysiology and outcomes of gout, the quality of care delivered to patients in Africa is still suboptimal. Existing data on gout in Africa reveals a general low index of suspicion due to limited knowledge of the disease by healthcare workers resulting in late diagnosis, with severe polyarticular tophaceous gout being a common presenting feature. These late presentations are associated with avoidable disability and increase the direct and indirect costs of managing gout. The challenges are related to lack of government budgetary support for staff training, infrastructure for diagnosis, and availing medicines. The picture of gout in Africa largely mirrors the west concerning risk factors, comorbidities, and burden of disease, but with some unique presentations seen in HIV, sickle cell disease, and vertigo. We discuss the challenges of gout diagnosis and management in Africa and propose a roadmap to improve gout outcomes across Africa.