Temporal trends in hyperuricaemia in the Irish health system from 2006-2014: A cohort study

Hyperuricemia and its related diseases: mechanisms and advances in therapy

Hyperuricemia, characterized by elevated levels of serum uric acid (SUA), is linked to a spectrum of commodities such as gout, cardiovascular diseases, renal disorders, metabolic syndrome, and diabetes, etc. Significantly impairing the quality of life for those affected, the prevalence of hyperuricemia is an upward trend globally, especially in most developed countries. UA possesses a multifaceted role, such as antioxidant, pro-oxidative, pro-inflammatory, nitric oxide modulating, anti-aging, and immune effects, which are significant in both physiological and pathological contexts. The equilibrium of circulating urate levels hinges on the interplay between production and excretion, a delicate balance orchestrated by urate transporter functions across various epithelial tissues and cell types. While existing research has identified hyperuricemia involvement in numerous biological processes and signaling pathways, the precise mechanisms connecting elevated UA levels to disease etiology remain to be fully elucidated. In addition, the influence of genetic susceptibilities and environmental determinants on hyperuricemia calls for a detailed and nuanced examination. This review compiles data from global epidemiological studies and clinical practices, exploring the physiological processes and the genetic foundations of urate transporters in depth. Furthermore, we uncover the complex mechanisms by which the UA induced inflammation influences metabolic processes in individuals with hyperuricemia and the association with its relative disease, offering a foundation for innovative therapeutic approaches and advanced pharmacological strategies.

Targeting Liver Xor by GalNAc-siRNA Is an Effective Strategy for Hyperuricemia Therapy

Hyperuricemia, i.e., increased plasma uric acid concentration, is a common problem in clinical practice, leading to gout or nephrolithiasis, and is associated with other disorders, such as metabolic syndrome, cardiovascular disease, and chronic renal disease. Xanthine oxidoreductase (XOR) is a critical rate-limiting enzyme involved in uric acid synthesis and a promising target for hyperuricemia therapy. However, XOR inhibitors currently face clinical problems such as a short half-life and side effects. Here, we found that specifically targeting liver Xor with GalNAc-siRNAs had a good therapeutic effect on hyperuricemia. First, siRNAs were designed to target various sites in the homologous region between Homo sapiens and Mus musculus Xor mRNA and were screened in primary mouse hepatocytes. Then, the siRNAs were modified to increase their stability in vivo and conjugated with GalNAc for liver-specific delivery. The effects of GalNAc-siRNAs were evaluated in three hyperuricemia mouse models, including potassium oxonate and hypoxanthine administration in WT and humanized XDH mice and Uox knockout mice. Febuxostat, a specific XOR inhibitor used for hyperuricemia treatment, was used as a positive control. Targeting liver Xor with GalNAc-siRNAs by subcutaneous administration reduced plasma uric acid levels, uric acid accumulation in the kidney, renal inflammation, and fibrosis, thereby alleviating kidney damage in hyperuricemia mouse models without hepatoxicity. The results demonstrated that targeting liver Xor with GalNAc-siRNAs was a promising strategy for hyperuricemia therapy.

Co-delivery of indomethacin and uricase as a new strategy for inflammatory diseases associated with high uric acid

Uric acid is the final metabolite in humans. High level of uric acid chronically induces urate deposition, aggravates kidney damage, and concomitantly causes an increase in inflammatory factors. Alleviating acute inflammation and decreasing uric acid levels are the key points in the treatment of inflammatory diseases associated with high uric acid. However, a drug delivery system that combines anti-inflammatory and uric acid reduction functions at the same time remains a challenge to be settled. Here, we designed a nanocrystal-based co-delivery platform, IND Nplex, characterized by loading of indomethacin (IND) and uricase. Compared with free IND or uricase, IND Nplex possessed a better anti-inflammatory effect by restraining the release of inflammation-related factors in vitro. In addition, pharmacokinetic and biodistribution studies revealed that IND Nplex significantly prolonged the retention time in vivo and was more concentrated in the kidney. In acute gouty arthritis model rats, IND Nplex markedly relieved ankle joint swelling and mitigated synovial inflammation. In acute kidney injury model rats, IND Nplex indicated better biocompatibility and significant amelioration of renal fibrosis. Moreover, IND Nplex showed the effect of anti-inflammatory and improved renal function via determination of inflammatory factors and biochemical markers in the serum and kidney. In conclusion, these results indicate that IND Nplex exerts anti-inflammatory activity and uric acid-lowering effect and could become a promising candidate for the treatment of uric acid-related diseases.

Correlation between remnant cholesterol and hyperuricemia in American adults

BACKGROUND

Remnant cholesterol (RC) is an important marker for assessing the risk of metabolic syndrome. However, the correlation between RC and hyperuricemia (HUA) remains unclear. This study aimed to explore the correlation between RC and HUA in American adults.

METHODS

A total of 9089 participants from the 2013-2020 National Health and Nutrition Examination Survey were investigated. The correlation between RC and the odds of HUA was evaluated using multivariate logistic regression analysis. The nonlinear correlation was described using fitted smoothed curves. The correlation in subgroups was analyzed based on race, gender, alcohol consumption, age, body mass index, waist circumference, diabetes and moderate physical activities.

RESULTS

RC was correlated with uric acid (Spearman's correlation coefficient = 0.208 in males and 0.215 in females; all P < 0.001). Multiple logistic regression analysis indicated a positive correlation between RC and the risk of HUA (odds ratio = 1.022 in males and 1.031 in females; all P < 0.001). Subgroup analysis revealed that the correlation was stronger in females, participants aged < 50 years, and those without diabetes. Furthermore, the generalized smooth curve fitting demonstrated a linear correlation between RC and HUA, without threshold or saturation effects.

CONCLUSION

Elevated RC significantly and positively correlated with HUA in American adults. This correlation was stronger among females, participants aged < 50 years, and those without diabetes.

Mechanisms of epigallocatechin gallate (EGCG) in ameliorating hyperuricemia: insights into gut microbiota and intestinal function in a mouse model

Epigallocatechin gallate (EGCG), a prominent bioactive compound found in tea, offers numerous health benefits. Previous studies have highlighted its potential in mitigating hyperuricemia. In this study, hyperuricemic mice induced by potassium oxonate (PO) were treated with EGCG or the anti-hyperuricemia medication allopurinol (AP) to investigate the mechanisms underlying their anti-hyperuricemic effects. The results demonstrated that both EGCG and AP significantly reduced serum uric acid (UA) levels. Further analysis revealed that EGCG promoted the expression of UA secretion transporter genes (Oat1 and Oct1) while inhibiting the expression of UA reabsorption transporter genes (Urat1 and Glut9) in the kidney. By 16S rDNA sequencing, EGCG, but not AP, was found to alter the composition of the gut microbiota. Notably, EGCG induced significant changes in the relative abundance of specific bacteria such as Lactobacillus, Faecalibaculum, and Bifidobacterium, which displayed high correlations with serum UA levels and UA-related gene expression. Metabolomic analysis suggested that EGCG-induced modifications in bacterial metabolites might contribute to the alleviation of hyperuricemia. Transcriptomic analysis of the intestinal epithelium identifies 191 differentially expressed genes (DEGs) in EGCG-treated mice, including 8 purine-related genes. This study elucidates the anti-hyperuricemic mechanisms of EGCG, particularly its influence on the gut microbiota and gene expression in the intestinal epithelium.

Correlation between remnant cholesterol and hyperuricemia in patients with type 2 diabetes mellitus: a cross-sectional study

BACKGROUND

Remnant cholesterol (RC) has been known as an important factor for the assessment of the metabolic syndrome (Mets) risk. However, the correlation between RC and hyperuricemia (HUA) in type 2 diabetes mellitus (T2DM) remains unclear. This study aims to explore the correlation between RC and HUA in patients with T2DM.

METHODS

A total of 2956 patients with T2DM admitted to the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from 2020 to 2022 were included. The correlation between RC and HUA was evaluated with Spearman's correlation, multiple logistic regression, subgroup analyses, receiver operating characteristic (ROC) curves analyses and generalized smooth curve fitting. Total cholesterol (TC) < 5.18mmol/L was defined as normal TC.

RESULTS

RC was correlated with uric acid in patients with T2DM (Spearman's correlation coefficient = 0.279, P < 0.001). According to the multiple logistic regression analyses, there was an independent positive correlation between RC and HUA (OR = 1.63, 95%CI = 1.40, 1.90). In addition, a non-linear correlation between RC and HUA was identified. The area under the ROC curve (AUC) of RC (0.658, 95%CI = 0.635, 0.681) was the largest compared with those of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and TC. Subgroup analyses showed a more significant positive correlation among females or normal TC groups.

CONCLUSION

Elevated RC is correlated with HUA in patients with T2DM significantly and positively. RC is better in its predictability for HUA than that of conventional lipid indexes.

Nonlinear relationship between oxidative balance score and hyperuricemia: analyses of NHANES 2007-2018

BACKGROUND

Limited data regarding the correlation between oxidative balance score (OBS) and hyperuricemia highlights the necessity for thorough investigations. This study aims to examine the link between OBS, which incorporates dietary and lifestyle factors, and the occurrence of hyperuricemia.

METHODS

We conducted a cross-sectional study involving 13,636 participants from the 2007-2018 National Health and Nutrition Examination Survey (NHANES). The oxidative balance score (OBS) was determined based on four lifestyle factors and sixteen dietary nutrients. We assessed the levels of serum uric acid (SUA) and the occurrence of hyperuricemia as outcomes. Weighted logistic regression and linear models were used for statistical analysis, using Restricted Cubic Splines (RCS) to examine potential nonlinear associations. Subgroup analysis and sensitivity assessments were performed to identify any variations and ensure the robustness of the findings.

RESULTS

Higher OBS was consistently correlated with decreased SUA levels and a reduced prevalence of hyperuricemia. RCS highlighted a significant negative nonlinear association, particularly in females. Subgroup analysis revealed gender-based differences and interactive correlation, providing additional insights regarding OBS and hyperuricemia relationship.

CONCLUSION

This study underscores a robust negative correlation between OBS and SUA levels as well as the incidence of hyperuricemia, emphasizing the importance of dietary and lifestyle factors. Incorporating RCS, subgroup analysis, and sensitivity assessments enhances the depth of our findings, providing valuable insights for further research.

The association of low serum uric acid with mortality in older people is modified by kidney function: National Health and Nutrition Examination Survey (NHANES) 1999-2018

BACKGROUND

In older individuals, the role of low serum uric acid (SUA) as risk factor for mortality is debated. We therefore studied whether SUA levels, particularly low SUA concentrations, are associated with all-cause and cardiovascular (CV) mortality in older population, and to clarify potential effect modification of kidney function.

METHODS

We identified 14,005 older people in National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. SUA was measured only at baseline. The relationship between SUA and mortality was assessed using Cox proportional hazards models and restricted cubic spline Cox regression stratified by the estimated glomerular filtration rate (eGFR).

RESULTS

During mean 8.3 years of follow-up, 4852 all-cause death and 1602 CV death were recorded. A significant U-shaped association was observed between SUA with all-cause mortality, with the lowest risk concentration of 5.5 mg/dL. Comparing to the reference group (5 to 7 mg/dL), the HR of 2 to < 5 mg/dL group was 1.11 (1.03-1.21) and 1.14 (1.00-1.30). This relationship was more pronounced in participants with an eGFR ≥ 60 ml/min/1.73m2 (HR, 1.16; 95%CI, 1.06-1.28). This situation similarly occurred in Urine protein negative group (HR, 1.14; 95%CI, 1.04-1.25).

CONCLUSIONS

Low SUA concentrations are associated with an increased risk in all-cause and CV mortality among older participants. Extremely low SUA concentrations are especially undesirable, especially in the older adults with normal kidney function.

Incidence density of hyperuricemia and association between metabolism-related predisposing risk factors and serum urate in Chinese adults: a cohort study

Background

Evidence regarding the association between metabolism-related indicators and serum urate (SU) is limited. We aimed to obtain the incidence density of hyperuricemia and to explore the association between metabolism-related predisposing risk factors and SU.

Methods

A total of 48,979 Chinese adults from the Beijing Physical Examination Center were included in the study. The partial least squares path model was used to explore the relationship between SU and metabolism-related risk factors. The generalized additive model was used for smooth curve fitting, showing the sex-specific associations of SU at follow-up with baseline fasting blood glucose (FBG) concentrations and age.

Results

The incidence density of hyperuricemia was 78/1000 person-years. Baseline SU, age, sex, obesity, FBG, and lipid metabolism were significantly associated with SU at follow-up (all P values <0.05). Non-linear relationships were found between the baseline FBG concentrations and SU at follow-up, while U-shaped associations were observed between baseline age and SU at follow-up.

Conclusions

The SU concentration is associated with several metabolism-related risk factors such as obesity and FBG. Recognition of these associations will aid in a deeper understanding of the multifaceted nature of SU regulation.

Overview of the pharmacokinetics and pharmacodynamics of URAT1 inhibitors for the treatment of hyperuricemia and gout

INTRODUCTION

Hyperuricemia is a common metabolic disease, which is a risk factor for gouty arthritis and ureteral stones and may also lead to cardiovascular and chronic kidney disease (CDK). Therefore, hyperuricemia should be treated early. Xanthine oxidase inhibitors (XOIs) and uricosuric agents (UAs), which target uric acid, are two types of medications that are used to treat gout and hyperuricemia. XOIs stop the body from producing excessive uric acid, while UAs eliminate it rapidly via the kidneys. Urate transporter 1 (URAT1) belongs to the organic anion transporter family (OAT) and is specifically localized to the apical membrane of the epithelial cells of proximal tubules. Unlike other organic anion transporter family members, URAT1 identifies and transports organic anions that are primarily responsible for urate transport.

AREAS COVERED

This article reviews the pharmacokinetics and pharmacodynamics of the existing URAT1 inhibitors to serve as a reference for subsequent drug studies.

EXPERT OPINION

The URAT1 inhibitors that are currently used as clinical drugs mainly include dotinurad, benzbromarone, and probenecid. Results indicate that RDEA3170 may be the most promising inhibitor, in addition to SHR4640, URC-102, and MBX-102, which are in the early stages of development.

Associations of Adipocytokines with The Development of Cardiovascular Events in Young People

The research was aimed to study the associations of adipocytokines with the risk of cardiovascular events and to determine the threshold values of adipocytes for the prognosis of cardiovascular events in a young population.

MATERIALS AND METHODS

The study is an epidemiological cohort study. The analysis included 1240 people aged 25-44 years. The endpoint was combined and included: death from cardiovascular disease, myocardial infarction, probable myocardial infarction, acute cerebrovascular accident, hospitalization for cardiovascular disease, and revascularization. Adipocytokines were determined with a MILLIPLEX panel.

RESULTS

In the examined population, 1.7% of cases of cardiovascular events were detected during cohort observation, of which 28.6% were fatal events. In men, cardiovascular endpoints were recorded 4.3 times more often than in women (17 (81%) vs. 4 (19%), p = 0.003). In individuals with cardiovascular events, arterial hypertension (2.6 times), diabetes mellitus (8.6 times), and overweight/obesity (1.5 times) were more often recorded compared to individuals without cardiovascular events. For tumor necrosis factor-alpha (TNFa), the threshold value was 2.5 pg/mL, with sensitivity assessment (Se) at 85.7% and specificity (Sp) at 83.3%. For amylin, the threshold value was 10.5 pg/mL, with Se at 73.7% and Sp at 67.0%. For pancreatic polypeptide (PP), the threshold value was 43.7 pg/mL, with Se at 85.7% and Sp at 56.7%.

CONCLUSION

A method for assessing the risk of cardiovascular events in young people includes determining the levels of amylin, PP, and TNFa in blood serum. The cut-off points for predicting cardiovascular events were levels of amylin above 10.5 pg/mL, PP above 43.7 pg/mL, or a decrease in TNFa below 3.8 pg/mL.

Association of impaired sensitivity to thyroid hormones with hyperuricemia through obesity in the euthyroid population

BACKGROUND

Impaired sensitivity to thyroid hormones is a newly proposed clinical entity associated with hyperuricemia in the subclinical hypothyroid population. However, it is unknown whether the association exists in the euthyroid population. This study aimed to explore the association of impaired sensitivity to thyroid hormones (assessed by the thyroid feedback quantile-based index [TFQI], parametric thyroid feedback quantile-based index [PTFQI], thyrotrophic thyroxine resistance index [TT4RI] and thyroid-stimulating hormone index [TSHI]) with hyperuricemia and quantify the mediating effect of body mass index BMI in the euthyroid population.

METHODS

This cross-sectional study enrolled Chinese adults aged ≥ 20 years who participated in the Beijing Health Management Cohort (2008-2019). Adjusted logistic regression models were used to explore the association between indices of sensitivity to thyroid hormones and hyperuricemia. Odds ratios [OR] and absolute risk differences [ARD] were calculated. Mediation analyses were performed to estimate direct and indirect effects through BMI.

RESULTS

Of 30,857 participants, 19,031 (61.7%) were male; the mean (SD) age was 47.3 (13.3) years; and 6,515 (21.1%) had hyperuricemia. After adjusting for confounders, individuals in the highest group of thyroid hormone sensitivity indices were associated with an increased prevalence of hyperuricemia compared with the lowest group (TFQI: OR = 1.18, 95% CI 1.04-1.35; PTFQI: OR = 1.20, 95% CI 1.05-1.36; TT4RI: OR = 1.17, 95% CI 1.08-1.27; TSHI: OR = 1.12, 95% CI 1.04-1.21). BMI significantly mediated 32.35%, 32.29%, 39.63%, and 37.68% of the associations of TFQI, PTFQI, TT4RI and TSHI with hyperuricemia, respectively.

CONCLUSIONS

Our research revealed that BMI mediated the association between impaired sensitivity to thyroid hormones and hyperuricemia in the euthyroid population. These findings could provide useful evidence for understanding the interaction between impaired sensitivity to thyroid hormone and hyperuricemia in euthyroid individuals and suggest the clinical implications of weight control in terms of impaired thyroid hormones sensitivity.

Prevalence and influencing factors of hyperuricemia in middle-aged and older adults in the Yao minority area of China: a cross-sectional study

Hyperuricemia (HUA) endangers human health, and its prevalence has increased rapidly in recent decades. The current study investigated HUA's prevalence and influencing factors in Gongcheng, southern China. A cross-sectional investigation was conducted; 2128 participants aged 30-93 years were included from 2018 to 2019. Univariate and multivariate logistic regression models were used to screen HUA variables. A Bayesian network model was constructed using the PC algorithm to evaluate the association between influencing factors and HUA. The prevalence of HUA was 15.6% (23.2% in men, 10.7% in women). After screening the variables using a logistic regression analysis model, fatty liver disease (FLD), dyslipidemia, abdominal obesity, creatinine (CREA), somatotype, bone mass, drinking, and physical activity level at work were included in the Bayesian network model. The model results showed that dyslipidemia, somatotype, CREA, and drinking were directly related to HUA. Bone mass and FLD were indirectly associated with HUA by affecting the somatotype. The prevalence of HUA in Gongcheng was high in China. The prevalence of HUA was related to somatotype, drinking, bone mass, physical activity level at work, and other metabolic diseases. A good diet and moderate exercise are recommended to maintain a healthy somatotype and reduce the prevalence rate of HUA.

Positive correlation between fatty liver index and hyperuricemia in hypertensive Chinese adults: a H-type hypertension registry study

Background

Few studies have examined the relationship between fatty liver index (FLI) and hyperuricemia (HUA). This study explores the relationship between FLI and HUA in hypertensive patients.

Methods

A total of 13,716 hypertensive subjects were included in the current study. FLI, a simple index calculated from triglycerides (TG), waist circumference (WC), body mass index (BMI), and γ -glutamyltransferase (GGT), was used as a useful predictor of nonalcoholic fatty liver disease (NAFLD) distribution. HUA was defined as serum uric acid ≥ 360 μmol/L for females and ≥ 420 μmol/L for males.

Results

The mean value of total FLI was 31.8 ± 25.1. Multiple logistic analyses revealed a significant positive correlation between FLI and HUA (OR, 1.78; 95% CI: 1.69-1.87). A subgroup analysis demonstrated that the correlation between FLI (< 30 vs. ≥ 30) and HUA was significant in both sexes (P for interaction = 0.006). Further analyses stratified by sex indicated a positive correlation between FLI and HUA prevalence among male and female subjects. However, the correlation between FLI and HUA was stronger in female subjects than in males (male: OR, 1.70; 95% CI: 1.58-1.83; female: 1.85; 95% CI: 1.73-1.98).

Conclusion

This study demonstrates a positive correlation between FLI and HUA in hypertensive adults, but stronger in females than males.

Hyperuricaemia: prevalence and association with mortality in an elderly Finnish population

OBJECTIVE

To establish the prevalence of hyperuricaemia in an elderly Finnish cohort and to assess its association with comorbidities and mortality.

DESIGN

Prospective cohort study.

SETTING

Good Ageing in Lahti Region study, Finland 2002-2012 (mortality data analysed until 2018).

PARTICIPANTS

2673 participants (mean age 64 years; 47% men).

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of hyperuricaemia in the study population was detected. Associations between hyperuricaemia and mortality were assessed using multivariable adjusted Cox proportional hazards models.

METHODS

Data from a prospective, population-based study of elderly people (52-76 years) in the Lahti region, Finland, were used. Information on serum uric acid (SUA) levels as well as several other laboratory variables, comorbidities, lifestyle habits and socioeconomic factors was collected, and the association between SUA level and mortality in a 15-year follow-up period was analysed.

RESULTS

Of 2673 elderly Finnish persons included in the study 1197 (48%) were hyperuricaemic. Hyperuricaemia was extremely prevalent in men (60%). There was an association between elevated SUA and mortality which remained after adjustment for potential confounding factors (age, gender, education, smoking status, body mass index, hypertension and dyslipidaemia). The adjusted HR for all-cause mortality among clearly hyperuricaemic individuals with SUA≥420 µmol/L compared with normouricaemic individuals (SUA<360 µmol/L) was 1.32 (95% CI 1.05 to 1.60) in women and 1.29 (95% CI 1.05 to 1.60) in men. In slightly hyperuricaemic individuals (SUA 360-420 µmol/L) the corresponding HRs were 1.03 (95% CI 0.78 to 1.35) and 1.11 (95% CI 0.89 to 1.39).

CONCLUSIONS

Hyperuricaemia is very prevalent in the elderly Finnish population and is independently associated with increased mortality.

Protective effect of sodium butyrate on intestinal barrier damage and uric acid reduction in hyperuricemia mice

PURPOSE

The goal of this study was to examine the role of sodium butyrate in preserving the intestinal mucosal barrier and reducing hyperuricemia (HUA).

METHODS

First, we established a mouse model of HUA via intraperitoneal injection of potassium oxonate together with a yeast-rich diet to detect the levels of serum uric acid (UA) and fecal short-chain fatty acids (SCFAs). Then, in vitro, different concentrations of UA and sodium butyrate (NaB) were used to treat LS174T and Caco2 cells. The effects of UA and NaB on the gut barrier were determined based on the expression levels of MUC2, ZO-1, and Occludin.Finally, C57BL/6 mice were used to model HUA, and these mice were administered 200 mg·kg^-1·d^-1 NaB by gavage to counter the HUA. The effect of NaB on HUA in the intestinal tract was elucidated by determining serum UA levels, inflammatory parameters, epithelial barrier integrity, and via histological analysis.

RESULTS

The data showed that the content of fecal SCFAs in HUA mice decreased. Additionally, in LS174T and Caco2 cells, NaB reversed the decrease of ZO-1, Occludin, and MUC2 protein expression caused by high UA levels. Furthermore, NaB decreased serum UA of HUA mice, and reversed both the decreased expression of MUC2, ZO-1, Occludin, and ABCG2 proteins and the increased level of inflammatory factors in the intestinal tissues of these mice.

CONCLUSION

The HUA mouse model showed intestinal barrier damage. NaB protected the intestinal barrier of HUA mice and reduced the serum UA level.

Trends in serum uric acid levels among Korean children and adolescents between 2016 and 2020: a nationwide study

The aim of this study was to examine trends in serum uric acid (SUA) levels over a recent 5-year period according to age, sex, obesity, and abdominal obesity among Korean children and adolescents. We conducted a serial cross-sectional analysis using nationally representative data from the Korea National Health and Nutritional Examination Survey from 2016 to 2020. The study outcome was trends in SUA levels. SUA trends were analyzed by survey-weighted linear regression analysis considering the survey year as a continuous variable. SUA trends were also analyzed for subgroups based on age, sex, abdominal obesity, or obesity. This study included 3,554 children and adolescents aged 10-18 years. SUA increased significantly over the study period in boys (p for trend = 0.043), but not in girls (p for trend = 0.300). In age-specific analyses, SUA increased significantly in the 10-12 years group (p for trend = 0.029). After adjusting for age, SUA increased significantly in the obese group of both boys (p for trend = 0.026) and girls (p for trend = 0.023), but not in the overweight, normal, or under-weight groups of either sex. After adjusting for age, SUA increased significantly in the abdominal obesity group of boys (p for trend = 0.017) and girls (p for trend = 0.014), but not in the non-abdominal obesity group of either sex.   Conclusion: In the current study, SUA levels significantly increased in both boys and girls with obesity or abdominal obesity. Further studies of the effect of SUA on health outcomes in boys and girls with obesity or abdominal obesity are needed. What is Known: • High serum uric acid (SUA) is a risk factor for various metabolic diseases, including gout, hypertension, and type 2 diabetes. What is New: • SUA levels increased in boys and the 10-12 years group of Korean children and adolescents. • SUA levels increased significantly in Korean children and adolescents with obesity or central obesity.

Risk of fatal and non-fatal cardiovascular events in men aged 25-44 in the city of Novosibirsk. Cohort study

Aim. To study the incidence and risk factors of cardiovascular events (CVEs) during an 8-year follow-up of a cohort of men aged 25-44 years (Novosibirsk).

Material and methods. The cohort study included 1415 people aged 37,33 [31,83; 41,92] years (Median, Me [interquartile range, Q25; Q75], of which 670 (47,3%) were men. Median follow-up period was 6,9 [5,8; 7,8] years. CVEs were identified using the "Registry of Acute Myocardial Infarction", fatal cases — from the "Medical Certificates of Cause of Death". The examination program included a questionnaire, anthropometry, biochemical studies. Statistical processing was carried out using SPSS (version 13.0).

Results. Thirteen CVEs were identified, of which 6 were fatal. Survival prognosis was more favorable in men without hypertension, with a heart rate (HR) <80 bpm. The risk of CVEs increased by 14% with an increase in fasting plasma glucose by 0,5 mmol/l, by 1,8 times with creatinine increase by 10 pmol/l (decreased by 29% with an increase in glomerular filtration rate by 5 ml/min /1,73 m2); 2 times with a heart rate increase by 10 bpm, regardless of other cardiometabolic risk factors.

Conclusion. Significant risk factors for fatal and non-fatal CVEs in men aged 25-44 years are hypertension, heart rate >80 bpm, increased fasting plasma glucose, creatinine levels (or decreased glomerular filtration rate).

New insight into the management of renal excretion and hyperuricemia: Potential therapeutic strategies with natural bioactive compounds

Hyperuricemia is the result of increased production and/or underexcretion of uric acid. Hyperuricemia has been epidemiologically associated with multiple comorbidities, including metabolic syndrome, gout with long-term systemic inflammation, chronic kidney disease, urolithiasis, cardiovascular disease, hypertension, rheumatoid arthritis, dyslipidemia, diabetes/insulin resistance and increased oxidative stress. Dysregulation of xanthine oxidoreductase (XOD), the enzyme that catalyzes uric acid biosynthesis primarily in the liver, and urate transporters that reabsorb urate in the renal proximal tubules (URAT1, GLUT9, OAT4 and OAT10) and secrete urate (ABCG2, OAT1, OAT3, NPT1, and NPT4) in the renal tubules and intestine, is a major cause of hyperuricemia, along with variations in the genes encoding these proteins. The first-line therapeutic drugs used to lower serum uric acid levels include XOD inhibitors that limit uric acid biosynthesis and uricosurics that decrease urate reabsorption in the renal proximal tubules and increase urate excretion into the urine and intestine via urate transporters. However, long-term use of high doses of these drugs induces acute kidney disease, chronic kidney disease and liver toxicity. Therefore, there is an urgent need for new nephroprotective drugs with improved safety profiles and tolerance. The current systematic review summarizes the characteristics of major urate transporters, the mechanisms underlying the pathogenesis of hyperuricemia, and the regulation of uric acid biosynthesis and transport. Most importantly, this review highlights the potential mechanisms of action of some naturally occurring bioactive compounds with antihyperuricemic and nephroprotective potential isolated from various medicinal plants.

Adherence to DASH Dietary Pattern and Its Association with Incident Hyperuricemia Risk: A Prospective Study in Chinese Community Residents

Hyperuricemia represents a great burden on global public health, and it is important to provide effective guidance at the level of dietary patterns. We evaluated the association between the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of hyperuricemia in a large-scale, community-based cohort in East China. In total, 45,853 participants that did not have either hyperuricemia nor gout were included and assigned a DASH dietary score based on their baseline dietary intake. They were then divided into five quintiles (Q1−Q5) according to their score, followed by cross-linkages with local health information systems and in-person surveys. Cox proportional hazards models were adopted to calculate hazard ratio (HR) and 95% confidence intervals (CIs). During a median follow-up of 4.54 years, 2079 newly diagnosed hyperuricemia cases were documented. Compared to the DASH Q1 group, the risk of incident hyperuricemia for the Q5 group was significantly reduced by 16% (HR: 0.84; 95% CIs: 0.72−0.97) in the adjusted model. The associations of DASH diet with hyperuricemia appeared stronger (P for interaction <0.001) among participants with 3−4 cardiometabolic diseases at baseline, compared with their counterparts. Our results suggest that the DASH diet could be taken into account in the recognition of risk population and the prevention of hyperuricemia.

AMP-activated protein kinase α2 contributes to acute and chronic hyperuricemic nephropathy via renal urate deposition in a mouse model

Hyperuricemia can induce acute and chronic kidney damage, but the pathological mechanism remains unclear. The potential role of AMP-activated protein kinase (AMPK) α2 in hyperuricemia-induced renal injury was investigated in this study. Acute and chronic hyperuricemic nephropathy was induced by administering intraperitoneal injections of uric acid and oxonic acid to AMPK α2 knockout and wild-type mice. Changes in renal function, histopathology, inflammatory cell infiltration, renal interstitial fibrosis, and urate deposition were analyzed. In both acute and chronic hyperuricemic nephropathy mouse models, knockout of AMPK α2 significantly reduced serum creatinine levels and renal pathological changes. The tubular expression of kidney injury molecule-1 was also reduced in hyperuricemic nephropathy mice deficient in AMPK α2. In addition, knockout of AMPK α2 significantly suppressed the infiltration of renal macrophages and progression of renal interstitial fibrosis in mice with chronic hyperuricemic nephropathy. Knockout of AMPK α2 reduced renal urate crystal deposition, probably through increasing the expression of the uric acid transporter, multidrug resistance protein 4. In summary, AMPK α2 is involved in acute and chronic hyperuricemia-induced kidney injury and may be associated with increased urate crystal deposition in the kidney.

Association of Total Calcium With Serum Uric Acid Levels Among United States Adolescents Aged 12-19 Years: A Cross-Sectional Study

Aims

Evidence of a link between total calcium (CA) and serum uric acid (SUA) is absent in adolescents. Thus, this study aimed to determine the relationship between total CA levels and SUA levels in United States adolescents.

Methods

A cross-sectional study analyzed a sample composed of 8,309 United States adolescents aged 12–19 years from the National Health and Nutrition Examination Survey database (1999–2006 survey cycle). Multivariable linear regression analyses and multivariable logistic regression analyses were used to assess the correlation of total CA with SUA levels and hyperuricemia. Furthermore, the dose-response relationship of total CA and SUA levels was analyzed using smooth curve fitting (penalized spline method).

Results

According to multivariable linear regression analysis, every 1 mg/dL increase in total CA level is associated with a 0.33 mg/dL (β = 0.33, 95% CI: 0.27–0.40, p < 0.001) increase in SUA. Multivariable logistic regression analyses showed that every 0.1 mg/dL increase in total CA level is linked with an 8% increased risk of hyperuricemia (OR = 1.08, 95% CI: 1.06–1.10, p < 0.001). The analyses of smooth curve fitting revealed that total CA levels were linearly correlated with SUA levels (P_{non–linearity} = 0.152). The results were highly stable in all subgroups. The interaction analysis results presented that race/ethnicity had an interactive role in associating total CA with SUA levels.

Conclusions

In United States adolescents, total CA levels were linearly and positively correlated with SUA levels.

The Impact of an Elevated Uric Acid Level on the Prevalence of Coronary Artery Disease in Pancreas Transplant Candidates with Type 1 Diabetes: A Cross Sectional Study

Pancreas transplantation is considered a high-risk surgery with cardiovascular complications. Early detection of all potential cardiovascular risk factors can decrease the perioperative risk and improve the pancreas recipients' outcome. The present study aims to evaluate the association between serum uric acid (UA) levels and the prevalence of coronary artery disease (CAD) in patients eligible for pancreas transplantation. We prospectively enrolled 63 consecutive patients with type 1 diabetes (T1D) who underwent cardiological evaluation before pancreas transplantation in our center. Participants underwent clinical evaluation, laboratory assays, and coronary angiography. The median concentration of UA in patients with CAD was significantly higher than in participants without CAD (6.43 (4.93-7.26) vs. 4.41 (3.64-5.49) mg/dL, p = 0.0002). We showed the positive correlation between UA concentration and systolic blood pressure, pulse pressure (PP) and triglycerides (r = 0.271, p = 0.032; r = 0.327, p = 0.009; r = 0.354, p = 0.004, respectively). In a multivariate analysis, the concentration of UA (OR 2.044; 95% CI: 1.261-3.311, p = 0.004) was independently associated with the prevalence of CAD in pancreas transplant candidates with T1D. We demonstrated that elevated UA levels were strongly associated with the high prevalence of CAD in pancreas transplant candidates with T1D. To stratify cardiovascular risk, the measurement of the UA concentration should be considered in all T1D patients qualified for pancreas transplantation.

The association of uric acid with mortality modifies at old age: data from the uric acid right for heart health (URRAH) study

OBJECTIVES

In older individuals, the role of serum uric acid (SUA) as risk factor for mortality is debated. This study investigated the association of SUA with all-cause and cardiovascular (CV) mortality in older adults participating in the large multicentre observational uric acid right for heart health (URRAH) study.

METHODS

Eight thousand URRAH participants aged 65+ were included in the analysis. The predictive role of SUA was assessed using Cox regression models stratified according to the cut-off age of 75. SUA was tested as continuous and categorical variable (age-specific quartiles). The prognostic threshold of SUA for mortality was analysed using receiver operating characteristic curves.

RESULTS

Among participants aged 65-74, multivariate Cox regression analysis adjusted for CV risk factors and comorbidities identified an independent association of SUA with both all-cause mortality (hazard ratio [HR] 1.169, 95% confidence interval [CI] 1.107-1.235) and CV mortality (HR 1.146, 95% CI 1.064-1.235). The cut-off value of 4.8 mg/dl discriminated mortality status. In participants aged 75+, we observed a J-shaped relationship of SUA with all-cause and CV mortality, with risk increasing at extreme SUA levels.

CONCLUSIONS

These results confirmed the predictive role of SUA for all-cause and CV mortality in older adults, while revealing considerable age-related differences. Mortality risk increased at higher SUA levels in participants aged 65-74, with a prognostic threshold of 4.8 mg/dl. The relationship between SUA and mortality was J-shaped in oldest participants. Large interventional studies are needed to clarify the benefits and possible risks of urate-lowering treatments in older adults.

Association between Dietary Fiber Intake and Hyperuricemia among Chinese Adults: Analysis of the China Adult Chronic Disease and Nutrition Surveillance (2015)

This study aimed to assess the association of dietary fiber intake with serum uric acid (SUA) levels and risk of hyperuricemia (HUA) among Chinese adults using the latest nationally representative data. A total of 66,427 Chinese adults aged 18 years and over from the China Adult Chronic Disease and Nutrition Surveillance in 2015 were included in this study. Dietary intakes were measured with a 3-day 24 h dietary recall and the household condiment weighing method. Mixed-effect linear and logistic regression models were used to evaluate the associations of dietary fiber intake with SUA levels and risk of HUA, respectively. Compared to the lowest intake group, the coefficient and 95% confidence in the highest intake group of total fiber were −0.06 (−0.08, −0.04) (p-trend < 0.001), −0.18 (−0.2, −0.16) (p-trend < 0.001) for cereal fiber, 0.03 (0.01, 0.04) (p-trend = 0.051) for legume fiber, 0 (−0.01, 0.02) (p-trend = 0.869) for vegetable fiber and 0.01 (−0.001, 0.04) (p-trend = 0.296) for fruit fiber. The odds ratio (OR) and 95% confidence interval (CI) of HUA for the highest vs. lowest intake group of total fiber were 0.88 (0.84, 0.91) (p-trend = 0.001), 0.67 (0.63, 0.71) (p-trend < 0.001) for cereal fiber, 1.05 (1, 1.09) (p-trend = 0.248) for legume fiber, 1.01 (0.97, 1.05) (p-trend = 0.982) for vegetable fiber and 1.06 (1, 1.12) (p-trend = 0.264) for fruit fiber. Our findings suggest that consumption of total fiber and cereal fiber were significantly inversely associated with SUA levels and HUA risk among the Chinese adult population. Developing and implementing effective public education programs are urgently needed to increase the intake of dietary fiber, especially cereal fiber among Chinese adults.

Which Clusters of Metabolic Syndrome Are the Most Associated with Serum Uric Acid?

Background and Objectives: Metabolic syndrome is defined as three or more of five components; therefore, there are 16 possible different clusters of metabolic risk factors that are under one diagnosis of metabolic syndrome. In this study, we evaluated the different clusters of metabolic syndrome (MetS) across serum uric acid (SUA) quartiles and analyzed the association of these clusters with SUA levels, respectively, in both men and women. Materials and Methods: A total of 606 subjects were recruited to a cross-sectional study from the ongoing Lithuanian High Cardiovascular Risk primary prevention program (LitHiR). All of the study subjects were diagnosed with MetS (according to the 2005 National Cholesterol Education Program Adult Treatment Panel III MetS definition). Results: In the middle-aged population of patients with MetS living in Lithuania, a high proportion of hyperuricaemia was detected—35.5% (95% Cl 31.7% to 39.4%). For women possessing all five MetS components, the chances of having hyperuricaemia are 2.807 higher than for women with three risk factors (p < 0.001). However, men do not have a statistically significantly higher chance of having hyperuricaemia, depending on the number of MetS components in our population. Using multivariable models, the statistically significant chance of having hyperuricaemia was observed only in women possessing all five MetS components (OR = 2.386, p < 0.0001), compared to any other of 15 MetS clusters. After adjustment for age and sex, the chance of having hyperuricaemia for individuals with the cluster of all five MetS components, compared to any other of 15 MetS clusters, remained (OR = 1.982, p = 0.001). Also, a lower probability (OR = 0.653, p = 0.039) of having hyperuricaemia was observed for individuals having the combination of abnormal plasma glucose, blood pressure, and waist circumference. Conclusions: Patients with the clustering of all five metabolic syndrome components are at higher risk for having hyperuricaemia than patients with any other combination of MetS clusters. This risk is even higher for women. It could be beneficial for patients presented with all five MetS components to be screened for SUA concentration in the primary CVD prevention program.

Development of chronic kidney disease influenced by serum urate and body mass index based on young-to-middle-aged Japanese men: a propensity score-matched cohort study

OBJECTIVE

To investigate the association between serum uric acid (SUA) level and body mass index (BMI) on the development of chronic kidney disease (CKD) in working men aged 20-60 years.

DESIGN

Retrospective cohort study.

SETTING

Data from employees' annual health check-ups were collected from two companies in 2009 and 2014.

PARTICIPANTS

A total of 16 708 working men were recruited. We excluded participants with missing essential data (N=7801), who had basal estimated glomerular filtration rate (eGFR) <60.0 mL/min/1.73 m² and/or proteinuria (N=698) or with the absence of follow-up data (N=2).

PRIMARY OUTCOME

eGFR <60 mL/min/1.73 m² and/or proteinuria (≥1+) in 2014 (defined as incident CKD).

RESULTS

The cut-off values of SUA for incident CKD were 6.6 mg/dL in both young (20-39 years old) and middle-aged (40-60 years old) men analysed by receiver operator characteristics. ORs for incident CKD were assessed on propensity score-matched (1:1) cohorts. In young participants (N=1938), after propensity score matching, a coexistence of high-level SUA (≥6.6 mg/dL) and overweight (BMI ≥25 kg/m²) was a significant risk factor of incident CKD (OR=2.18, 95% CI 1.10 to 4.31, p=0.025), but high-level SUA was not an independent risk factor without overweight status (p=0.174). In middle-aged participants (N=2944) after propensity score matching, high-level SUA was a significant risk factor of incident CKD both with or without overweight (OR=1.44, 95% CI 1.02 to 2.04, p=0.037; OR=1.32, 95% CI 1.01 to 1.73, p=0.041, respectively).

CONCLUSION

These findings suggest that high-level SUA is strongly associated with incident CKD in overweight young adult men.

Psoriatic arthritis with hyperuricemia: more peripheral, destructive, and challenging to treat

Objective

To study the impact of hyperuricemia on clinical presentation, severity, and associated comorbidities of psoriatic arthritis (PsA).

Methods

Retrospective bicentric case–control study performed in Strasbourg and Colmar, France, from 2009 to 2019. Patients with PsA (according to ICD-10 coding) and at least one available serum urate (SU) measurement were included. Demographic, comorbidities, clinical, and radiographic data were collected. Hyperuricemia was defined as SU level ≥ 360 µmol/L.

Results

We included 242 patients: 73 (30.2%) had hyperuricemia and 15 (6.2%) met 2015 ACR/EULAR criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more frequently male (72.6% vs 39.1%, p = 1.6 × 10⁻⁶) with higher body mass index (30.9 vs 28.7 kg/m², p = 0.015) and more comorbidities (Charlson comorbidity index: 2.6 vs 1.8, p = 0.005). PsA started at an older age (47.5 vs 43 years, p = 0.016) was more polyarticular (56.2% vs 41.9%, p = 0.049) than axial (9.6% vs 22.8%, p = 0.019) and more destructive (52.8% vs 37.4%, p = 0.032). PsA patients with joint destruction more frequently had hyperuricemia than did others (37.6% vs 25.8%, p = 0.047). Multivariable analysis confirmed the association of hyperuricemic PsA with peripheral joint involvement (odds ratio 2.98; 95% confidence interval 1.15–7.75; p = 0.025) and less good response to treatment (0.35; 0.15–0.87; p = 0.024).

Conclusion

Patients with hyperuricemic PsA show poorer response to PsA treatment and have more peripheral and destructive joint damage than normo-uricemic patients.

Key Points • Gout and psoriatic arthritis (PsA) can co-exist in the same patient. • Monosodium urate crystals might have a deleterious impact on PsA. • Hyperuricemic PsA is more polyarticular, less frequently axial, and more destructive than normo-uricemic PsA. • PsA with hyperuricemia should lead to more personalized medicine.

Hyperuricemia: Features of the Diet

The association of hyperuricemia (HU) with cardiovascular disease (CVD), diabetes, metabolic syndrome, and kidney disease has been demonstrated in numerous studies. НU is the main pathogenetic factor in the development of gout and is associated with an increase in overall and cardiovascular mortality. НU is included in the list of factors determining cardiovascular risk. According to epidemiological studies, there is a high prevalence of HU in the world and its increase in recent decades. A number of factors have been identified that contribute to the increased risk of НU. Non-modifiable factors include gender, age, genetic factors, and modifiable factors include diet and lifestyle. Nutritional unbalances, increased life expectancy, increased prevalence of obesity, and increased use of drugs (especially diuretics) are seen as contributing factors to the rise in НU. The review was carried out to summarize the available information on the effect of dietary habits, individual foods and nutrients on serum uric acid (SUA) levels and the risk of developing HU. The review presents the results of scientific studies demonstrating the relationship of НU with the consumption of foods rich in purines (offal, red meat, fish, seafood, legumes), alcohol consumption, drinks sweetened with fructose, coffee, dairy products, vegetables and fruits. Diet correction is an important and necessary step in the prevention and treatment of НU. The article reviews the basic principles of dietary management in HU and provides dietary recommendations for patients. For effective prevention and treatment of НU, a mandatory correction of the diet is required.

High-level uric acid in asymptomatic hyperuricemia could be an isolated risk factor of cardio-cerebrovascular diseases: A prospective cohort study

BACKGROUND AND AIMS

Whether the asymptomatic hyperuricemia (AH) raise the cardiovascular disease risk with or without hyperuricemia-related comorbidities still remains contentious. Our study was aimed to quantitatively access the incidence risk of coronary heart disease (CHD) and stroke associated with AH.

METHODS AND RESULTS

In this prospective cohort study, multivariate-adjusted Cox regression models were applied to evaluate the risk of cardiovascular disease (CVD). Baseline serum uric acid beyond normouricemia (357 mmol/L) was quarterly stratified based on the distribution of healthy populations without CVD onset. 1062 CVD first-attack cases were collected among the 29,974 study population (age range: 18-91, mean age: 47.2 ± 13.9 years-old) with a mean follow-up duration of 5.78 ± 0.83 years. The AH showed overall non-association with the CVD incident. However, significantly increased adjusted hazard ratio (HR) of CVD with 95% confidence interval (CI) were observed when the fourth quartile compared with normouricemia stratum in the total cohort population (CHD: 1.42, 1.21-1.68; stroke: 1.27, 1.06-1.41), male (CHD: 1.26, 1.12-1.55), female (CHD: 1.34, 1.04-2.02; stroke: 2.06, 1.13-3.77) and aged over 50 years-old population. Meanwhile, the age-standardized incidence rate of CVD in the fourth quartile was 2-3 times higher than the normouricemia population. After excluded 14,464 baseline population with diabetes, dyslipidemia, and hypertension, consistent results were also observed in the AH population in absence of comorbidities (CHD: 1.51, 1.22-2.25; stroke: 1.68, 1.13-2.39).

CONCLUSION

Asymptomatic hyperuricemia patients exposed to a higher level of uric acid (>=428 mmol/L) could significantly increase the incidence risk of CHD and stroke, with or without hyperuricemia-related comorbidities.

Dapagliflozin Added to Verinurad Plus Febuxostat Further Reduces Serum Uric Acid in Hyperuricemia: The QUARTZ Study

CONTEXT

Combining a sodium-glucose cotransporter 2 inhibitor with a xanthine oxidase inhibitor (XOI) and a urate transporter 1 (URAT1) inhibitor may enhance serum uric acid (sUA) lowering. However, concerns exist regarding high urinary UA (uUA) excretion rates and subsequent crystallization in renal tubules.

OBJECTIVE

To assess whether dapagliflozin added to verinurad, a selective URAT1 inhibitor, and febuxostat, an XOI, increases uUA excretion.

DESIGN

Randomized, placebo-controlled, 2-way crossover study (NCT03316131).

PATIENTS

Adults with asymptomatic hyperuricemia.

INTERVENTIONS

Subjects (N = 36) were randomized to oral once-daily 9 mg verinurad plus 80 mg febuxostat plus 10 mg dapagliflozin for 7 days and 7 days of oral once-daily 9 mg verinurad plus 80 mg febuxostat plus placebo with an intervening 7- to 21-day washout period.

MAIN OUTCOME MEASURE

Difference in peak uUA excretion between groups from baseline to day 7. Secondary outcomes included changes in sUA levels and 24-h uUA excretion.

RESULTS

Both regimens lowered mean peak uUA excretion (least squares mean changes from baseline: -12.9 mg/h [95% confidence interval (CI): -21.0 to -4.7], dapagliflozin; -13.2 mg/h [95% CI -21.3 to -5.0], placebo). sUA concentrations were lower with dapagliflozin (mean treatment difference -62.3 µmol/L [95% CI -82.8 to -41.8]). Dapagliflozin did not impact verinurad pharmacokinetics, its main metabolites, or febuxostat or fasting plasma glucose levels vs verinurad plus febuxostat. There were no clinically relevant changes in safety parameters.

CONCLUSIONS

Dapagliflozin further reduced sUA without influencing uUA excretion, suggesting that its combination with verinurad and febuxostat at the doses tested does not adversely affect kidney function.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03316131.

Temporal trends in hyperuricaemia among adults in Wuhan city, China, from 2010 to 2019: a cross-sectional study

OBJECTIVES

Hyperuricaemia is a risk factor for gout attacks, kidney damage and cardiovascular events. Evidence on the trends in hyperuricaemia burden in Wuhan city, China, was limited. The present study aimed to estimate the prevalence of and a decade trend in hyperuricaemia in Wuhan city.

DESIGN

Cross-sectional study.

SETTING

Health Management Center of Tongji Hospital.

PARTICIPANTS

A total of 732 527 adult participants from the general population who took a physical examination in the Health Management Center between 2010 and 2019.

MAIN OUTCOME MEASURES

Prevalence of and trends in hyperuricaemia.

RESULTS

The overall prevalence of hyperuricaemia was 25.8% (36.6% in men and 10.8% in women) in 2019. The hyperuricaemia prevalence and serum uric acid (SUA) levels were significantly higher in young men, old women and participants with obesity, hypertension, diabetes or dyslipidaemia (p<0.05). SUA levels among men and women gradually increased from 358.0 (313.0-407.0) umol/L and 250.0 (217.0-288.0) umol/L in 2010 to 388.0 (338.0-445.2) umol/L and 270.0 (233.0-314.0) umol/L in 2019, respectively, p<0.05. From 2010 through 2019, hyperuricaemia prevalence significantly increased in each age category and it increased most sharply among participants aged 20-39 years. The multivariate-adjusted prevalence among men was 26.1% (25.4% to 26.7%) in 2010, 30.9% (30.4% to 31.4%) in 2015 and 34.4% (34.1% to 34.8%) in 2019, while among women it was 5.8% (5.4% to 6.2%) in 2010, 7.2% (6.9% to 7.5%) in 2015 and 10.1% (9.9% to 10.3%) in 2019.

CONCLUSIONS

Hyperuricaemia was highly prevalent among adults in Wuhan city. More attention should be paid to the increasing burden of hyperuricaemia, especially for those at higher risks.

The Epidemiology and Genetics of Hyperuricemia and Gout across Major Racial Groups: A Literature Review and Population Genetics Secondary Database Analysis

Gout is an inflammatory condition caused by elevated serum urate (SU), a condition known as hyperuricemia (HU). Genetic variations, including single nucleotide polymorphisms (SNPs), can alter the function of urate transporters, leading to differential HU and gout prevalence across different populations. In the United States (U.S.), gout prevalence differentially affects certain racial groups. The objective of this proposed analysis is to compare the frequency of urate-related genetic risk alleles between Europeans (EUR) and the following major racial groups: Africans in Southwest U.S. (ASW), Han-Chinese (CHS), Japanese (JPT), and Mexican (MXL) from the 1000 Genomes Project. The Ensembl genome browser of the 1000 Genomes Project was used to conduct cross-population allele frequency comparisons of 11 SNPs across 11 genes, physiologically involved and significantly associated with SU levels and gout risk. Gene/SNP pairs included: ABCG2 (rs2231142), SLC2A9 (rs734553), SLC17A1 (rs1183201), SLC16A9 (rs1171614), GCKR (rs1260326), SLC22A11 (rs2078267), SLC22A12 (rs505802), INHBC (rs3741414), RREB1 (rs675209), PDZK1 (rs12129861), and NRXN2 (rs478607). Allele frequencies were compared to EUR using Chi-Square or Fisher’s Exact test, when appropriate. Bonferroni correction for multiple comparisons was used, with p < 0.0045 for statistical significance. Risk alleles were defined as the allele that is associated with baseline or higher HU and gout risks. The cumulative HU or gout risk allele index of the 11 SNPs was estimated for each population. The prevalence of HU and gout in U.S. and non-US populations was evaluated using published epidemiological data and literature review. Compared with EUR, the SNP frequencies of 7/11 in ASW, 9/11 in MXL, 9/11 JPT, and 11/11 CHS were significantly different. HU or gout risk allele indices were 5, 6, 9, and 11 in ASW, MXL, CHS, and JPT, respectively. Out of the 11 SNPs, the percentage of risk alleles in CHS and JPT was 100%. Compared to non-US populations, the prevalence of HU and gout appear to be higher in western world countries. Compared with EUR, CHS and JPT populations had the highest HU or gout risk allele frequencies, followed by MXL and ASW. These results suggest that individuals of Asian descent are at higher HU and gout risk, which may partly explain the nearly three-fold higher gout prevalence among Asians versus Caucasians in ambulatory care settings. Furthermore, gout remains a disease of developed countries with a marked global rising.

Prevalence of Hyperuricemia and the Use of Allopurinol in Older Poles-Results from a Population-Based PolSenior Study

BACKGROUND

Our study analyzes the frequency and risk factors of hyperuricemia and the use of allopurinol in a representative cohort of the older Polish adult population.

METHODS

The analysis was a part of a cross-sectional PolSenior study on aging in Poland. The complete medication data were available in 4873 out of 4979 community dwelling respondents aged 65 and over. Serum uric acid concentrations were evaluated in 4028 participants (80.9% of the cohort).

RESULTS

Hyperuricemia was observed in 28.2% of women and 24.7% of men. Ten risk factors of hyperuricemia were selected based on multivariable LASSO logistic regression analysis. Nine factors showed significant odds ratios: eGFR < 60 mL/min/1.73 m2 (OR = 4.10), hypertriglyceridemia (OR = 1.88), obesity (OR = 1.75), heart failure (1.70), CRP > 3.0 mg/dL (OR = 1.64), coronary artery disease (OR = 1.30), use of loop-diuretics (OR = 4.20), hydrochlorothiazide (OR = 2.96), and thiazide-like diuretics (OR = 2.81). Allopurinol was used by 2.8% of men and 1.8% of women. The therapy was considered effective in 46.7% of men and 53.3% of women.

CONCLUSIONS

Hyperuricemia was present in 23.1% (95% CI: 21.8-24.4) of the older Polish population. The frequency of hyperuricemia increases with age, reaching 30.5% in men and 33.7% in women aged 90 years or more. Chronic kidney disease, obesity, heart failure, hypertriglyceridemia, and the use of diuretics were the strongest risk factors for hyperuricemia in older adults. The treatment with allopurinol was ineffective in more than half of participants.

Inulin supplementation ameliorates hyperuricemia and modulates gut microbiota in Uox-knockout mice

Purpose

Inulin is a type of fermentable dietary fiber, which is non-digestible, and can improve metabolic function by modulating intestinal microbiota. This study aimed to evaluate the role of inulin in hyperuricemia and microbial composition of the gut microbiota in a mouse model of hyperuricemia established through knockout of Uox (urate oxidase) gene.

Methods

KO (Uox-knockout) and WT (wild-type) mice were given inulin or saline by gavage for 7 weeks. The effect of inulin to combat hyperuricemia was determined by assessing the changes in serum UA (uric acid) levels, inflammatory parameters, epithelial barrier integrity, fecal microbiota alterations, and SCFA (short-chain fatty acid) concentrations in KO mice.

Results

Inulin supplementation can effectively alleviate hyperuricemia, increase the expressions of ABCG2 in intestine, and downregulate expression and activity of hepatic XOD (xanthine oxidase) in KO mice. It was revealed that the levels of inflammatory cytokines and the LPS (lipopolysaccharide) were remarkably higher in the KO group than those in the WT group, indicating systemic inflammation of hyperuricemic mice, but inulin treatment ameliorated inflammation in KO mice. Besides, inulin treatment repaired the intestinal epithelial barrier as evidenced by increased levels of intestinal TJ (tight junction) proteins [ZO-1 (zonula occludens-1) and occluding] in KO mice. Moreover, serum levels of uremic toxins, including IS (indoxyl sulfate) and PCS (p-cresol sulfate), were reduced in inulin-treated KO mice. Further investigation unveiled that inulin supplementation enhanced microbial diversity and raised the relative abundance of beneficial bacteria, involving SCFAs-producing bacteria (e.g., Akkermansia and Ruminococcus). Additionally, inulin treatment increased the production of gut microbiota-derived SCFAs (acetate, propionate and butyrate concentrations) in KO mice, which was positively correlated with the effectiveness of hyperuricemia relief.

Conclusions

Our findings showed that inulin may be a promising therapeutic candidate for the treatment of hyperuricemia. Moreover, alleviation of hyperuricemia by inulin supplementation was, at least, partially conciliated by modulation of gut microbiota and its metabolites.

Electronic supplementary material

The online version of this article (10.1007/s00394-020-02414-x) contains supplementary material, which is available to authorized users.

Real-world treatment of gout and asymptomatic hyperuricemia: A cross-sectional study of Japanese health insurance claims data

OBJECTIVES

To assess gout and asymptomatic hyperuricemia in Japan and review treatment conditions.

METHODS

This retrospective cross-sectional study analyzed the prevalence of hyperuricemia and gout, and characteristics and treatment of patients with those conditions, using Japanese health insurance claims and medical check-up data collected from April 2016 through March 2017.

RESULTS

Among 2,531,383 persons registered in the database, 1.1% (men 1.9%, women <0.1%) were diagnosed with gout and 2.6% (4.1%, 0.4%) with asymptomatic hyperuricemia. Medical check-ups showed 13.4% (19.6%, 1.0%) of patients with hyperuricemia (serum uric acid [sUA] > 7.0 mg/dL). Urate-lowering therapy (ULT) was prescribed for 80.7% of patients identified with gout and 72.4% identified with asymptomatic hyperuricemia. ULT adherence was satisfactory, but most patients were treated with low-dose ULT. Less than half of patients receiving ULT achieved the sUA target (≤6.0 mg/dL). In gout patients, the incidence of gout flare was 47.8% (0.74 flares/person-year).

CONCLUSIONS

Although hyperuricemia prevalence is similar in Japan and worldwide, gout is comparatively rare in Japan. Gout and asymptomatic hyperuricemia are often treated with low-dose ULT, and many patients fail to reach target sUA, suggesting that gout management is suboptimal in Japan. Patients would benefit from stricter focus on a treat-to-target approach for gout management.

Update on the epidemiology, genetics, and therapeutic options of hyperuricemia

Hyperuricemia may occur when there is an excess of uric acid in the blood. Hyperuricemia may result from increased production or decreased excretion of uric acid. Elevated uric acid levels are a risk factor for gout, and various risk factors, including some medications, alcohol consumption, kidney disease, high blood pressure, hypothyroidism, and pesticide exposure, as well as obesity, are associated with an elevated risk of hyperuricemia. Although the mechanisms underlying the pathogenesis of hyperuricemia are complex, previously reported studies have revealed that hyperuricemia is involved in a variety of biological processes and signaling pathways. In this review, we summarize common comorbidities related to hyperuricemia and describe an update of epidemiology, pathogenesis, and therapeutic options of hyperuricemia. This systematic review highlights the epidemiology and risk factors of hyperuricemia. Moreover, we discuss genetic studies on hyperuricemia to uncover current status and advances in the pathogenesis of hyperuricemia. Additionally, we conclude with a reflection on the underlying mechanisms of hyperuricemia and present the alternative drug strategies for the treatment of hyperuricemia to offer more effective clinical interventions.

Hyperuricemia versus lifestyle in men and women of the Russian Federation population

Objective ― Analyzing gender-related specificities of hyperuricemia associations with lifestyle choices in the Russian Federation (RF) population. Material and Methods ― Cross-sectional survey was performed within the guidelines of the Russian national multicenter study ESSE-RF. The final sample size was 20781 people 25-64 years old. The effect of age, body mass index (BMI), diet, smoking status, and alcohol consumption on the incidence of hyperuricemia was evaluated. The analysis was carried out separately for men and women, using logistic regression. To build a model for predicting hyperuricemia, classification trees were used. Results ― Multidirectional associations of hyperuricemia were revealed both in women (with BMI, age, ‘Smart’ dietary pattern, alcohol consumption) and in men (with BMI, ‘smart’ dietary pattern, alcohol consumption, smoking status). The predictive accuracy of hyperuricemia incidence models was 60.4% in women vs. 65.7% in men. In both gender groups, BMI had the highest contribution to predicting the hyperuricemia incidence, while the next predictors, in terms of significance, differed among men and women. In women, the greatest impact, in decreasing order, was exerted by age, dietary patterns and drinking, whereas in men, by smoking status, dietary patterns and drinking. Conclusion ― In the RF population, there are multiple gender-specific associations of hyperuricemia with lifestyle choices, particularly nutrition, smoking and alcohol consumption.

Sex- and age-specific variations, temporal trends and metabolic determinants of serum uric acid concentrations in a large population-based Austrian cohort

Little is known about sex- and age-specific variations and temporal trends in serum uric acid (SUA) concentrations, the prevalence of hyperuricemia and its association with metabolic risk factors in the general population. Between January 1, 1985 and June 30, 2005 146,873 participants (42% women) were recruited. Prevalence of hyperuricemia was estimated applying a common (SUA > 360 µmol/L) and sex-specific cut-off points (women > 340 µmol/L, men > 420 µmol/L). At baseline, mean age was 41.2 years in men and 51.5 years in women, mean SUA concentration was 314.8 µmol/L and 243.6 µmol/L, respectively. Applying a common cut-off point, the prevalence of hyperuricemia was 18.5% in men and 4.4% in women and by sex-specific cut-off points it was 15.1% and 13.8%, respectively. SUA levels increased by 6.7 µmol/L per decade in men, but remained constant in women until the age of 50 years with a sharp increase by approximately 22 µmol/L per decade thereafter. In men and women, hyperuricemia was associated with obesity, hypertriglyceridemia and elevated gamma-glutamyl transferase. With increasing age SUA levels and the prevalence of hyperuricemia rise in a sex-specific manner. Above the age of 65 years, the sex-specific prevalence of hyperuricemia in women outreaches that in men.

Does hyperuricemia correlate with intervertebral disc degeneration?

Gout is a form of crystal arthropathy associated with deposition of monosodium urate (MSU) crystals, and is directly related to hyperuricemia arising from abnormal purine metabolism and/or decreased uric acid excretion. Uric acid is the final oxidation product of purine metabolism and plays an important role as an in vivo antioxidant at physiological concentrations. Several case reports have described the presence of tophi in the intervertebral disc (IVD) or endplate of patients with hyperuricemia or gout, and these patients also exhibited severe intervertebral disc degeneration (IDD). We speculated that uric acid may have dual effects on an IVD. On the one hand, physiological concentrations of uric acid have powerful antioxidant activity and can effectively maintain the steady state of the IVD, while on the other hand, high concentrations of uric acid have strong oxidizing activity and the resulting high osmotic pressure can aggravate IDD. Moreover, when MSU crystals accumulate in the endplate and IVD, they lead to a series of mechanical damages and inflammatory reactions that further accelerate IDD. Further basic and clinical studies are needed to clarify the mechanism for the involvement of uric acid in the onset and development of IDD.

Metabolic Syndrome and 5-Year Incident Hyperuricemia Among Older Chinese Adults: A Community-Based Cohort Study

BACKGROUND

There was a lack of studies focusing on older adults about the longitudinal association between metabolic syndrome (MetS) and hyperuricemia (HUA). We aimed to assess the association of baseline MetS and incident HUA among older Chinese adults, with a special focus on the associations between different combinations of MetS components and HUA.

METHODS

Data of 3247 Chinese adults aged 60 years or older included in a community-based longitudinal cohort study were analyzed. Anthropometric examinations and collection of blood sample were conducted both at baseline and follow-up. HUA was defined as 7 mg/dl or above for men and 6 mg/dl or greater for women. MetS was assessed based on the National Cholesterol Education Program-Adult Treatment Panel III, and older adults with the presence of at least three of MetS components were considered as having MetS.

RESULTS

MetS and its components, including high blood pressure (BP), high body mass index, diabetes mellitus and high triglycerides, were significantly related to incident HUA. The association between high BP and incident HUA is strongest among the five MetS components. Among all combinations of MetS components, the group consisting of diabetes mellitus, high BP and high triglycerides had the highest odds for incident HUA (OR = 13.07, 95% CI = 4.95-34.54).

CONCLUSION

MetS and its components, except for low high-density lipoprotein cholesterol, could increase the risk of HUA among community-dwelling older adults, and high BP may be the most important determinant.

Sex-Specific Differences in the Association of Metabolically Healthy Obesity With Hyperuricemia and a Network Perspective in Analyzing Factors Related to Hyperuricemia

BACKGROUND

Although obesity is a well-known risk factor for hyperuricemia, it remains unclear whether obese subjects with metabolically healthy status have a decreased the risk of hyperuricemia and whether sex modifies the association of metabolically healthy obesity (MHO) with hyperuricemia risk. We aimed to investigate the sex-specific association between MHO and other obesity phenotypes and hyperuricemia, and to use Bayesian networks to determine and visualize the interactions among hyperuricemia and its related factors.

METHODS

This study was conducted using data from the China Health and Nutrition Survey 2009. Hyperuricemia was defined as serum uric acid ≥ 420 μmol/L in men and ≥ 360 μmol/L in women according to the guidelines. Body mass index (BMI) was used to define normal weight, overweight, and obese status in subjects, and metabolic health state was defined by the Adult Treatment Panel (ATP)-III and Visceral Adiposity Index (VAI) criteria, respectively. Subjects were categorized into six phenotypes according to their metabolic health and BMI level status.

RESULTS

Of the 7,364 Chinese adult individuals included, the prevalence of hyperuricemia among MHO women was only 8.5% (95% CI 4.8 to 14.3%), but increased to 30.7% among MUO women, whereas the highest prevalence among men was found in the MUOW phenotype (39.4%, 95% CI 35.4 to 43.6%), compared to 15.4% for male subjects with MHO. After adjusting for confounders, the MHO phenotype was significantly associated with an increased risk of hyperuricemia compared with their MHNW counterparts in women (OR: 1.95, 95% CI: 1.02-3.74) whereas a significant association was not found in men (OR: 1.46, 95% CI: 0.8-2.68). A complex network structure was established by BNs and then used to find connections between hyperuricemia and its related factors, as well as their interrelationships. By using BN reasoning, the probability of having hyperuricemia was 0.076 among MHO men, while it reached 0.124 in MHO women.

CONCLUSIONS

In conclusion, our results demonstrated that the MHO phenotype was significantly associated with the risk of hyperuricemia only in women, not in men. This sex-specific differences in the association may suggest a favorable condition of MHO for Chinese men with respect to hyperuricemia risk, meanwhile more attention should be paid to the increased risk of hyperuricemia among MHO women.

Dose-response relationship between higher serum calcium level and higher prevalence of hyperuricemia: A cross-sectional study

The aim of the study was to examine the relationship between serum calcium (Ca) levels and the prevalence of hyperuricemia (HU).The data included in this analysis were extracted from a population-based study conducted at the Xiangya Hospital Health Management Centre. Serum Ca levels were measured using the Arsenazo III method. HU was defined as the uric acid ≥416 μmol/L for male subjects, and ≥360 μmol/L for female subjects. The association between serum Ca levels and the prevalence of HU was evaluated using logistic and spline regression.The present study included a total of 6337 subjects. The overall prevalence of HU for the target population was 17.5%. Compared with the lowest quintile, the odds ratios adjusted by age, sex, body mass index, smoking, and drinking for HU were 1.51 [95% confidence interval (CI): 1.20-1.91], 1.43 (95% CI: 1.13-1.82), 2.02 (95% CI: 1.61-2.54), and 2.54 (95% CI: 2.02-3.18) for the second, third, fourth, and fifth quintiles of serum Ca levels, respectively (P for trend <.001), and a positive dose-response relationship was observed. Similar results were observed for men and women, respectively. The findings were not materially altered by the adjustment for further potential confounders.Subjects with higher serum Ca levels are subject to a higher prevalence of HU in a dose-response relationship manner.

Prevalence and risk factors associated with hyperuricemia among working population at high altitudes: a cross-sectional study in Western China

Chronic exposure to high altitude may lead to hyperuricemia. We investigated the prevalence of hyperuricemia and its risk factors among employees in high-altitude areas. A cross-sectional survey with cluster sampling was performed at 23 worksites on the Qinghai-Tibet Plateau. Subjects were evaluated by using questionnaires, anthropometric and laboratory measurements, and abdominal ultrasound. A multilevel logistic regression model and restricted cubic spline were used to explore the associated factors of hyperuricemia. Of the 4198 employees included in the study, the age-standardized prevalence of hyperuricemia was 28.1% (95% confidence interval (CI) 26.7-29.5), with 31.9% (95%CI 30.2-33.6) in men and 17.9% (95%CI 15.7-20.1) in women. Hypertension, hyperlipidemia, and a meat-food pattern were positively associated with hyperuricemia in both sexes, while diabetes, shift work, body mass index, non-alcoholic fatty liver disease, and low intake of fruits and vegetables were significantly associated with hyperuricemia only in men. Furthermore, a nonlinear dose-response association between the number of cardiovascular risk factors (CRFs) and hyperuricemia was observed. Compared with those having 0 CRFs, the full-adjusted odds ratios (ORs) and 95%CIs for 1, 2, and ≥ 3 CRFs were 1.76 (95%CI 1.25-2.47), 2.54 (95%CI 1.81-3.55), and 3.05 (95%CI 2.16-4.31) in men, respectively, and 2.13 (95%CI 1.43-3.17), 2.78 (95%CI 1.71-4.53), and 3.13 (95%CI 1.50-6.55) in women, respectively. Hyperuricemia is common in employees at high-altitude areas. However, working at higher altitudes does not mean necessarily higher risk of hyperuricemia, as dietary factors and clustered CRFs are more significant. Thus, workplace-based lifestyle modifications should be promoted.

Association between hyperuricemia and nontraditional adiposity indices

BACKGROUND

The association between several novel adiposity indices and hyperuricemia is inconclusive. Therefore, we aimed to investigate this association so as to provide theoretical support for the management of hyperuricemia in overweight/obese individuals.

METHODS

A cross-sectional study was carried out among 174,698 adults. The values of body adiposity index (BAI), conicity index (CI), a body shape index (ABSI), body roundness index (BRI), visceral adiposity index (VAI), lipid accumulation product (LAP) index, and cardiometabolic index (CMI) were divided into four quartiles, and multivariate logistic analysis was used to analyze the association between them and hyperuricemia. Receiver operating characteristic curve and area under curve (AUC) were used to evaluate the power of predictions for hyperuricemia.

RESULTS

After adjusting for confounding variables, LAP and CMI exhibited stronger association with hyperuricemia than other indices. The odd ratio (OR) for hyperuricemia in the highest quartile of the LAP and CMI was 2.049 (CI 95% = 1.824-2.302) and 4.332(CI 95% = 3.938-4.765). The AUC value of LAP was 0.632 (95% CI = 0.626-0.637), p < 0.001; and the AUC value of CMI was 0.687 (95% CI = 0.682-0.692), p < 0.001. The optimal cutoff values of LAP and CMI were 26.21 and 0.485, respectively.

CONCLUSIONS

LAP and CMI, combination of WC and lipid parameters and reliable visceral adiposity indices, were strongly associated with hyperuricemia than other indices. So they could be potential monitoring indicators for hyperuricemia management in overweight/obese individuals.

Increasing trend of asymptomatic hyperuricemia under treatment with urate-lowering drugs in Japan

Objectives: To describe recent trends in the prevalence of gout and asymptomatic hyperuricemia regarding urate-lowering treatment (ULT) in Japan. Methods: A database of health insurance claims managed by the Japan Medical Data Center was used to estimate the annual prevalence of gout and asymptomatic hyperuricemia during 2010-2014. ULT was evaluated for status of the two diseases during the same period. The significance of time trends was evaluated by Cochrane-Armitage trend test. Results: The prevalence of physician-diagnosed gout in men aged 20-64 years was 1.54% (95% CI: 1.49%-1.58%) in 2010, with a slight but significant (p < 0.001) annual increase, up to 1.66% (95% CI: 1.62%-1.71%) in 2014. In women, gout prevalence was somewhat constant about 0.09% during 2010-2014. Among male patients with gout, 78% received ULT. The prevalence of male patients with asymptomatic hyperuricemia in the same age range, who received ULT, increased significantly from 1.77% (95% CI: 1.72%-1.81%) to 2.14% (95% CI: 2.09%-2.19%) during 2010-2014 (p < 0.001). Conclusion: Gout prevalence in adult men in Japan has increased significantly in recent years. The prevalence of asymptomatic hyperuricemia under ULT has also increased significantly and was higher than that of gout.