Time course of serum uric acid accumulation and the risk of diabetes mellitus

Early onset of hyperuricemia is associated with the risk of nonalcoholic fatty liver disease across life course

BACKGROUND AND AIM

Hyperuricemia is associated with nonalcoholic fatty liver disease (NAFLD), whereas whether the association differed by hyperuricemia onset age remained unclear. This study sought to investigate the associations of hyperuricemia onset age with the risk of incident NAFLD across adulthood.

METHODS AND RESULTS

Based on Kailuan prospective cohort, our analysis comprised 3318 new-onset hyperuricemia cases from 2006 to 2015 and 3318 age- and sex-matched controls who were randomly selected from the general population. The risk of NAFLD across the onset age groups (<45, 45-54, 55-64, and ≥65 years) were compared using multivariable-adjusted Cox regression models. During a median follow-up of 6.78 years, 744 (22.42%) hyperuricemia participants and 586 (17.66%) normouricemia participants were diagnosed with incident NAFLD. After adjusted for potential confounders, the risk of NAFLD was gradually attenuated with each decade increase in hyperuricemia onset age. The adjusted hazard ratio (95% confidence interval) was 1.62 (1.33-1.97) for hyperuricemia onset age <45 years, 1.26 (1.01-1.57) for age of 45-54 years, 1.24 (1.00-1.59) for age of 55-64 years, and 1.19 (0.90-1.71) for age ≥65 years, respectively. The trend remained robust among the multiple sensitivity analyses.

CONCLUSIONS

The relative risk of incident NAFLD differed across hyperuricemia onset age-group, and the association was more evident in those with a younger age of hyperuricemia onset, highlighting the importance of performing early strategies on the prevention of NAFLD.

J-shaped association of serum uric acid with all-cause and cardiovascular mortality in patients with diabetic kidney disease

AIMS

The association of serum uric acid (SUA) with mortality remains unclear in patients with diabetic kidney disease (DKD). Thus, this prospective cohort study aimed to explore the association of SUA with all-cause and cardiovascular disease (CVD) mortality among patients with DKD in a large, nationally representative sample.

METHODS

This cohort study included data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 and the National Death Index mortality data until 31 December 2019. The restricted cubic spline and the Cox proportional hazards regression were conducted to describe the association of SUA with all-cause and CVD mortality and evaluate potential nonlinear associations.

RESULTS

The analysis included 3470 patients with DKD from NHANES 1999-2018. During the follow-up time of 24,633 person-years, we recorded 1489 all-cause deaths, including 542 CVD deaths. We identified a J-shaped association of SUA with all-cause and CVD mortality. The corresponding inflection points were observed at 5.1 and 5.7 mg/dL. When SUA were higher than inflection points, each 1 mg/dL increase in SUA was linked to a 13% and 22% higher risk of all-cause (HR: 1.13; 95% CI: 1.07-1.20;P < 0.001) and CVD (HR: 1.22; 95% CI: 1.06-1.41;P = 0.006) mortality, respectively.

CONCLUSIONS

This study indicated the J-shaped association of SUA with all-cause and CVD mortality in patients with DKD. The corresponding inflection points were 5.1 mg/dL for all causes and 5.7 mg/dL for CVD, respectively. More clinical randomized trials are needed to confirm the optimal uric acid-lowering target.

Cumulative remnant cholesterol burden increases the risk of cardiovascular disease among young adults

BACKGROUND

Previous studies have shown that remnant cholesterol (RC) was associated with cardiovascular disease (CVD) among middle-aged or older adults. However, lack of evidence on long-term exposures to RC and their role in CVD risk among young adults. We thus aimed to explore the association between cumulative RC burden and CVD in young adults.

METHODS

We enrolled participants younger than 45 years free of CVD history in the Kailuan Study who completed the first three health examinations from 2006 to 2010. Cumulative RC burden included cumulative RC burden score, time-weighted cumulative RC, exposure duration of high RC, and time course of RC accumulation. The outcome was the incidence of CVD. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) between cumulative RC burden and CVD risk.

RESULTS

A total of 15,219 participants were included (73.70% male, median age 39.13 years). During a median follow-up duration of 8.71 years (interquartile range: 8.4-9.15 years), 502 individuals developed CVD. After adjustment for traditional cardiovascular risk factors, highest risk of CVD was observed in participants with the highest cumulative RC burden score (HR, 1.66; 95% CI, 1.29-2.12), the highest quartile time-weighted cumulative RC (HR,1.50; 95% CI, 1.15-1.96), the longest exposure duration of high RC (HR, 1.71; 95% CI, 1.21-2.42), and those with cumulative RC burden and positive slope (HR, 1.79; 95% CI, 1.35-2.36).

CONCLUSIONS

Cumulative RC burden increased the risk of CVD among young adults, suggesting that maintaining low RC levels throughout young adulthood may minimize CVD risk.

KEY LEARNING POINTS

Association between cumulative atherogenic index of plasma exposure and risk of myocardial infarction in the general population

BACKGROUND

Atherogenic index of plasma (AIP) has been confirmed as a novel marker for myocardial infarction (MI), but few evidence on the long-term AIP and MI risk in general populations. We thus aimed to evaluate the relationships of cumulative exposure to AIP and its accumulation time course with the risk of MI.

METHODS

A total of 54,440 participants were enrolled in the Kailuan study. Time-weighted cumulative AIP was calculated as the weighted sum of the mean AIP value for each time interval, then normalized by total exposure duration, the exposure duration was from 2006 to 2010. Duration of high AIP exposure was defined as the duration with high AIP and ranged from 0 to 6 years. The time course of AIP accumulation was categorized by the combination of time-weighted cumulative AIP < or ≥ median (- 0.12) and AIP slope.

RESULTS

After 11.05 years of follow-up, 766 incident MI cases were documented. After adjustment for potential confounders, higher risk of MI was observed in participants with the highest time-weighted cumulative AIP quartile (HR, 1.89; 95% CI 1.47-2.43), the longest exposure duration of high AIP (HR, 1.52; 95% CI 1.18-1.95), and those with high time-weighted cumulative AIP and negative slope (HR, 1.42; 95% CI 1.13-1.79).

CONCLUSIONS

Long-term cumulative exposure to AIP and the time course of AIP accumulation increased the risk of MI. High AIP earlier resulted in a greater risk increase than later in life with the same time-weighted cumulative AIP, emphasizing the importance of controlling atherogenic dyslipidemia early in life.

Relationship between baseline and changed serum uric acid and the incidence of type 2 diabetes mellitus: a national cohort study

Objective

To explore the correlation between baseline serum uric acid (SUA) and SUA changes with the incidence of type 2 diabetes mellitus (T2DM) among middle-aged and older individuals.

Method

Binary logistic regression was used to calculate the odds ratio (ORs) and 95% confidence intervals (CIs) of the effects of baseline and changes in SUA on the incidence of T2DM. Stratified analysis was conducted based on sex, and the SUA levels were classified into four quartiles to assess the effect of baseline and relative changes in SUA on the incidence of T2DM. Furthermore, interaction analysis was performed between body mass index (BMI) and SUA, age and SUA, and sex and SUA.

Results

In the cohort study, the highest quartiles of SUA were significantly correlated with an increased incidence of T2DM among females in model 1 [OR = 2.231 (1.631, 3.050)], model 2 [OR = 2.090 (1.523, 2.867)], model 3 [OR = 2.075 (1.511, 2.849)], and model 4 [OR = 1.707 (1.234, 2.362)]. The highest quartiles of SUA had a statistically significant effect on the incidence of T2DM among all participants in model 1 [OR = 1.601 (1.277, 2.008)], model 2 [OR = 1.519 (1.204, 1.915)], model 3 [OR = 1.597 (1.257, 2.027)], and model 4 [OR = 1.380 (1.083, 1.760)]. Regarding the relative change of SUA, the highest quantiles of SUA were significantly correlated with an increased incidence of T2DM among females in model 1 [OR = 1.409 (1.050, 1.890)], model 2 [OR = 1.433 (1.067, 1.926)], and model 3 [OR = 1.420 (1.056, 1.910)], and there was a statistically significant correlation with incident T2DM among all participants in model 4 [OR = 1.346 (1.079, 1.680)] after adjusting for all covariates. However, there was no significant correlation between baseline, relative, and absolute changes in SUA and the incidence of T2DM among males. The interaction analysis demonstrated that sex, BMI, and the relative changes in SUA had a combined effect on the incidence of T2DM, while age and the changes in SUA had a joint effect on the incidence of T2DM only in females.

Conclusion

There was a positive association between SUA and the incidence of T2DM for all participants. However, significant sex differences in incidence were observed only in women, not men.

Association of the time course of Chinese visceral adiposity index accumulation with cardiovascular events in patients with hypertension

BACKGROUND

The Chinese visceral adiposity index (CVAI), a simple surrogate measure of visceral fat, is significantly associated with cardiovascular disease (CVD) risk in the general population. This study aimed to evaluate the association of cumulative CVAI (cumCVAI) exposure and its accumulation time course with CVD risk among patients with hypertension.

METHODS

This prospective study involved 15,350 patients with hypertension from the Kailuan Study who were evaluated at least three times in the observation period of 2006 to 2014 (2006-2007, 2010-2011, and 2014-2015) and who were free of myocardial infarction and stroke before 2014. The cumCVAI was calculated as the weighted sum of the mean CVAI for each time interval (value × time). The time course of CVAI accumulation was categorized by splitting the overall accumulation into early (cumCVAI_06 - 10) and late (cumCVAI_10 - 14) accumulation, or the slope of CVAI versus time from 2006 to 2014 into positive and negative.

RESULTS

During the 6.59-year follow-up period, 1,184 new-onset CVD events were recorded. After adjusting for confounding variables, the hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD were 1.35 (1.13-1.61) in the highest quartile of cumCVAI, 1.35 (1.14-1.61) in the highest quartile of the time-weighted average CVAI, 1.26 (1.12-1.43) in those with a cumulative burden > 0, and 1.43 (1.14-1.78) for the group with a 10-year exposure duration. When considering the time course of CVAI accumulation, the HR (95% CI) for CVD was 1.33 (1.11-1.59) for early cumCVAI. When considering the combined effect of cumCVAI accumulation and its time course, the HR (95% CI) for CVD was 1.22 (1.03-1.46) for cumCVAI ≥ median with a positive slope.

CONCLUSIONS

In this study, incident CVD risk depended on both long-term high cumCVAI exposure and the duration of high CVAI exposure among patients with hypertension. Early CVAI accumulation resulted in a greater risk increase than later CVAI accumulation, emphasizing the importance of optimal CVAI control in early life.

The correlation between dietary inflammatory index and risk of hyperuricemia in the U.S. population

The dietary inflammatory index (DII) has been reported to be related to chronic diseases as a novel inflammatory marker. However, the correlation between DII score and hyperuricemia in adults in the United States is still unclear. Therefore, our goal was to explore the correlation between them. A total of 19,004 adults were enrolled in the National Health and Nutrition Examination Survey from 2011 to 2018. DII score was calculated according to 28 dietary items obtained by 24-hour dietary interview data. Hyperuricemia was defined by serum uric acid level. We used multilevel logistic regression models and subgroup analysis to determine whether the 2 were associated. DII scores were positively associated with serum uric acid and the risk of hyperuricemia. Per unit increased in DII score was associated with a 3 mmol/L increase in serum uric acid in males (β 3.00, 95% confidence interval (CI) 2.05-3.94) and 0.92mmol/L in females (β 0.92, 95% CI 0.07-1.77), respectively. Compared with the lowest tertile of DII score, the rise of DII grade increased the risk of hyperuricemia among the whole participants (T2: odds ratio (OR) 1.14, 95% CI 1.03, 1.27; T3: OR 1.20 [1.07, 1.34], P for trend = .0012) and males [T2: 1.15 (0.99, 1.33), T3: 1.29 (1.11, 1.50), P for trend = .0008]. For females, the correlation between DII score and hyperuricemia was statistically significant in the subgroup stratified by body mass index (BMI) (BMI < 30, OR 1.08, 95% CI 1.02-1.14, P for interaction = .0134), which indicates that the association depends on BMI. In the United States male population, the DII score has a positive correlation with hyperuricemia. Anti-inflammatory dietary intake can be beneficial for lower serum uric acid.

Association of Elevated Serum Uric Acid with Nerve Conduction Function and Peripheral Neuropathy Stratified by Gender and Age in Type 2 Diabetes Patients

Background: The relationship between serum uric acid (SUA) level and diabetic peripheral neuropathy (DPN) remains controversial. We aimed to investigate the association between SUA level and DPN and evaluate the effects of SUA level on nerve conduction function via electromyography in patients with type 2 diabetes (T2DM), stratified by gender and age. Methods: This cross-sectional study included 647 inpatients with T2DM from the First Affiliated Hospital of Wenzhou Medical University between February 2017 and October 2020. The diagnosis of DPN was confirmed according to the Toronto Expert Consensus. Clinical data, SUA level, and nerve conduction parameters were obtained from electronic medical records. Results: A total of 647 patients with T2DM were included, and 471 patients were diagnosed with DPN. The level of SUA was higher in the DPN group than in the Non-DPN group (330.58 ± 99.67 vs. 309.16 ± 87.04, p < 0.05). After adjustment, a higher SUA level was associated with the presence of DPN [odds ratio (OR) 1.003, 95% confidence interval (CI), 1.001−1.005; p = 0.017]. The area under the curve for the prediction of DPN was 0.558 (95% CI, 0.509−0.608; p = 0.022), and the optimized cut-off of SUA level was 297.5 µmol/L. The SUA > 297.5 µmol/L level was independently associated with DPN in the male subgroup (OR 2.507, 95% CI, 1.405−4.473; p = 0.002) rather than in the female subgroup. Besides, SUA > 297.5 µmol/L was independently associated with DPN in the younger subgroup (age < 65 years) (OR 2.070, 95% CI, 1.278−3.352; p = 0.003) rather than in the older subgroup. In multiple linear regression analysis, SUA was significantly correlated with certain nerve conduction study parameters in the all patients group, and was also observed in the male and younger subgroups. Conclusions: Elevated SUA was independently associated with poorer nerve conduction functions, and hyperuricemia was also significantly associated with a higher risk of developing DPN in T2DM patients, especially in male and younger patients.

Time course of the triglyceride glucose index accumulation with the risk of cardiovascular disease and all-cause mortality

Background

Future risk of cardiovascular disease (CVD) and mortality is associated with cumulative amount TyG index (cumTyG) exposure, while whether time course of TyG accumulation modulates the risk remains unclear. This study sought to examine the associations of cumTyG index accumulation time course with the risk of CVD and all-cause mortality.

Methods

We enrolled 51,734 participants free of CVD and underwent three examinations at year 2006, 2008, and 2010. CumTyG from baseline to the third examination was calculated. Time course of cumTyG accumulation was calculated as the slope of TyG versus time from 2006 to 2010, or as splinting the overall TyG index accumulation into early (cumTyG_{06 − 08}) and late accumulation (cumTyG_{08 − 10}). Participants were categorized by the combination of cumTyG < or ≥ median (34.44 × years) and a negative or positive TyG slope.

Results

During a median follow-up of 9.04 years, we identified 3,602 incident CVD cases and 3,165 deaths. The risk of CVD and all-cause mortality increased with decreased TyG slope, the corresponding adjusted hazard ratio (aHR) with 95% confidence interval (CI) was 1.11 (1.04–1.19) and 1.18 (1.10–1.26) for patients with a negative TyG slope, respectively. Consistently, a later accumulation of TyG index was not associated with the risk of CVD and all-cause mortality after adjustment for an early accumulation. When considering the combination of cumTyG index and time course, participants with a cumTyG ≥ median and a negative TyG slope had elevated risk of CVD (aHR, 1.37; 95% CI, 1.24–1.51) and all-cause mortality (aHR, 1.28; 95% CI, 1.15–1.43). Additionally, the association was more prominent in young adults.

Conclusion

Early TyG index accumulation resulted in a greater risk of CVD and all-cause mortality than later TyG later accumulation with the same overall cumulative exposure, emphasizing the importance of optimal TyG index control earlier in life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-022-01617-2.