Association between dyslipidemia and serum uric acid levels in Korean adults: Korea National Health and Nutrition Examination Survey 2016-2017

Assessing levels of uric acid and other cardiovascular markers in prehypertensive and hypertensive adults

INTRODUCTION

Although some studies have reported the association between uric acid (UA) and hypertension, evidence on prehypertension is still lacking. Therefore, the objective of this study was to determine the levels of UA and other cardiovascular markers among prehypertensive and hypertensive patients and assess their risk for developing arterial hypertension.

METHODS

157 individuals were recruited: 67 normotensive, 23 pre-hypertensive and 67 hypertensive. Blood samples were collected to measure biochemical parameters and anthropometric measurements and blood pressure were evaluated. We calculated the product of lipid accumulation and the visceral adiposity index to assess cardiovascular risk.

RESULTS

Our data showed an increase in UA levels in normotensives (4.9±1.3mg/dL), prehypertensives (5.2±1.3mg/dL) and hypertensives (5.9±1.6mg/dL) (p=0.004). We found a higher frequency of hyperuricemia in the hypertensive group (34.3%) than in the normotensive group (13.4%, p<0.05). Hypertensive volunteers had lower levels of HDL-C (p=0.004 and p=0.003) and higher body mass indexes (p<0.001 and p=0.007), glucose (p<0.001 and p=0.033), triglycerides (p=0.001 and p=0.005), visceral adiposity index (p<0.001 and p=0.002) and lipid accumulation product (p<0.001 and p=0.007) than normotensive and prehypertensive participants. We also observed that individuals with UA≥6.2mg/dL had an increased risk of hypertension of 4.77 (p=0.003) compared to individuals with levels≤4.3mg/dL.

CONCLUSION

Our results showed that UA is associated with increased blood pressure and unfavorable changes in anthropometric and biochemical parameters, which represent risk factors for hypertension and cardiovascular diseases.

Metabolomics of human umbilical vein endothelial cell-based analysis of the relationship between hyperuricemia and dyslipidemia

BACKGROUND AND AIMS

Hyperuricemia frequently accompanies dyslipidemia, yet the precise mechanism remains elusive. Leveraging cellular metabolomics analyses, this research probes the potential mechanisms wherein hyperuricemia provokes endothelial cell abnormalities, inducing disordered bile metabolism and resultant lipid anomalies.

METHODS AND RESULTS

We aimed to identify the differential metabolite associated with lipid metabolism through adopting metabolomics approach, and thereafter adequately validating its protective function on HUVECs by using diverse assays to measure cellular viability, reactive oxygen species, migration potential, apoptosis and gene and protein levels of inflammatory factors. Taurochenodeoxycholic acid (TCDCA) (the differential metabolite of HUVECs) and the TCDCA-involved primary bile acid synthesis pathway were found to be negatively correlated with high UA levels based on the results of metabolomics analysis. It was noted that compared to the outcomes observed in UA-treated HUVECs, TCDCA could protect against UA-induced cellular damage and oxidative stress, increase proliferation as well as migration, and decreases apoptosis. In addition, it was observed that TCDCA might protect HUVECs by inhibiting UA-induced p38 mitogen-activated protein kinase/nuclear factor kappa-B p65 (p38MAPK/NF-κB p65) pathway gene and protein levels, as well as the levels of downstream inflammatory factors.

CONCLUSION

The pathogenesis of hyperuricemia accompanying dyslipidemia may involve high uric acid levels eliciting inflammatory reactions and cellular damage in human umbilical vein endothelial cells (HUVECs), mediated through the p38MAPK/NF-κB signaling pathway, subsequently impinging on cellular bile acid synthesis and reducing bile acid production.

Association between low-density lipoprotein cholesterol levels and serum uric acid to serum creatinine ratio in Chinese male gout patients

This study aimed to evaluate the association between low-density lipoprotein cholesterol (LDL-C) and serum uric acid to serum creatinine (SUA/SCr) ratio in male gout patients at different BMIs. This real-world study included 956 male gout patients aged 18-83 years. We retrospectively analyzed the medical records of Chinese male gout patients from 2017 to 2019. The correlation between LDL-C and SUA/SCr was tested after adjusting for confounding factors. We found a nonlinear relationship between LDL-C and SUA/SCr in the whole study population. Stratification analysis showed that there was actually a nonlinear relationship between LDL-C and SUA/SCr in men with a BMI of 24-28, the inflection point of LDL-C was 1.8 mmol/L, when LDL-C was greater than 1.8 mmol/L, there was a positive correlation between LDL-C levels and SUA/SCr (β = 0.67, 95% CI 0.35-0.98, P < 0.001). Moreover, LDL-C showed a significant positive correlation with SUA/SCr with a BMI of 28 or greater (β = 0.30, 95% CI 0.05-0.55, P = 0.019). However, no association was found between LDL-C and SUA/SCr with a BMI of less than 24 (β = 0.42, 95% CI - 0.03-0.86, P = 0.070). LDL-C levels were associated with SUA/SCr in Chinese male gout patients, but this correlation appeared inconsistent among different BMIs. Our findings suggest that LDL-C levels may be more noteworthy in overweight and/or obese male gout patients.

Alterations in lipidome profiles distinguish early-onset hyperuricemia, gout, and the effect of urate-lowering treatment

BACKGROUND

Currently, it is not possible to predict whether patients with hyperuricemia (HUA) will develop gout and how this progression may be affected by urate-lowering treatment (ULT). Our study aimed to evaluate differences in plasma lipidome between patients with asymptomatic HUA detected ≤ 40 years (HUA ≤ 40) and > 40 years, gout patients with disease onset ≤ 40 years (Gout ≤ 40) and > 40 years, and normouricemic healthy controls (HC).

METHODS

Plasma samples were collected from 94 asymptomatic HUA (77% HUA ≤ 40) subjects, 196 gout patients (59% Gout ≤ 40), and 53 HC. A comprehensive targeted lipidomic analysis was performed to semi-quantify 608 lipids in plasma. Univariate and multivariate statistics and advanced visualizations were applied.

RESULTS

Both HUA and gout patients showed alterations in lipid profiles with the most significant upregulation of phosphatidylethanolamines and downregulation of lysophosphatidylcholine plasmalogens/plasmanyls. More profound changes were observed in HUA ≤ 40 and Gout ≤ 40 without ULT. Multivariate statistics differentiated HUA ≤ 40 and Gout ≤ 40 groups from HC with an overall accuracy of > 95%.

CONCLUSION

Alterations in the lipidome of HUA and Gout patients show a significant impact on lipid metabolism. The most significant glycerophospholipid dysregulation was found in HUA ≤ 40 and Gout ≤ 40 patients, together with a correction of this imbalance with ULT.

Association between vegetarian diet and gouty arthritis: A retrospective cohort study

BACKGROUND AND AIMS

A vegetarian diet is rich in vegetables, fruits, and soy products. Although vegetarian diet is beneficial for improving the health outcomes such as body mass index, metabolic syndrome, cardiovascular disease, and mortality rate, the association between a vegetarian diet and gout incidence is not well known.

METHODS AND RESULTS

We linked the MJ Health Survey Data and MJ Biodata 2000 with the National Health Insurance Research Database (NHIRD) and the National Registration of Death (2000-2018). Information on the diet was collected from the MJ Health Survey Data, and the incidence of gouty arthritis was confirmed using the NHIRD. The Kaplan-Meier survival curve and log-rank test were used to compare the differences between vegetarian and non-vegetarian participants. Cox regression models were used to estimate the risk of the incidence of gouty arthritis. Among 76,972 participants, 37,297 (48.46%) were men, 2488 (3.23%) were vegetarians and the mean age was 41.65 ± 14.13 years. The mean baseline uric acid level was 6.14 ± 1.65 mg/dL. A total of 16,897 participants developed gouty arthritis, including 16,447 (22.08%) non-vegetarians and 450 (18.9%) vegetarians over a mean follow-up of 19 years. Significant differences were observed in the Kaplan-Meier survival curves between vegetarians and non-vegetarians (log-rank p < 0.001). Vegetarians had a significantly decreased incidence of gouty arthritis compared with non-vegetarians (hazard ratio = 0.87, 95% confidence interval = 0.78-0.98, p = 0.02) after adjusting for potential confounders.

CONCLUSION

People with a vegetarian diet had a significantly decreased risk of developing gouty arthritis compared with non-vegetarians in Taiwan.

Associations of serum uric acid with cardiovascular disease risk factors: a retrospective cohort study in southeastern China

OBJECTIVE

To evaluate the associations between serum uric acid (SUA) levels and cardiovascular disease (CVD) risk factors, focusing on potential sex-specific differences.

DESIGN

A retrospective cohort study.

SETTING

A large community-based survey was conducted every two years from 2010 to 2018 in Hangzhou, Zhejiang Province, outheastern China.

PARTICIPANTS

6119 participants aged 40 years and above who underwent at least three times of physical examinations were enrolled.

METHODS

Participants were categorised into four groups (Q1-Q4) based on baseline SUA quartiles within the normal range, with hyperuricaemia (HUA) as the fifth group. The Q1 was the reference. By stratifying participants by gender, the relationships between SUA levels and systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) and total cholesterol (TC) were investigated using linear regression models in the generalised estimating equation. Additionally, the associations of elevated SUA levels and HUA with hypertension, hyperglycaemia and dyslipidaemia were correspondingly examined using multivariate logistic regression models.

RESULTS

After adjusting for confounding variables, we found positive associations between SUA levels and SBP, DBP, FBG and TC in women, and with TC in men (p<0.01). Likewise, elevated SUA quartiles and HUA were linked to increased dyslipidaemia risk in both sexes, and increased hyperglycaemia risk only in women, with HRs (95% CI) of 1.64 (1.05 to 2.55) and 2.37 (1.47 to 3.81) in the Q4 and HUA group, respectively. Women with HUA had higher hypertension risk (HR=1.45, 95% CI 1.21 to 1.73), while no such association was observed in men. Stratified analyses revealed significant associations between elevated SUA levels and CVD risk factors in postmenopausal and non-obese women.

CONCLUSIONS

Elevated SUA levels increase the risk of dyslipidaemia in both sexes. SUA levels within normal range and HUA are positively associated with hyperglycaemia and hypertension in postmenopausal women, but not in men.

Associations between obesity parameters and hyperuricemia by sex, age, and diabetes mellitus: A nationwide study in Korea

OBJECTIVE

We investigated the associations between obesity parameters and the risk of hyperuricemia among Korean adults by sex, age, and diabetes mellitus status.

METHODS

This study analyzed data from 17,753 adults from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2018. Multivariable logistic regression analyses were conducted to examine the associations of body mass index (BMI), waist circumference (WC), and general and abdominal obesity with the risk of hyperuricemia (serum uric acid ≥7.0 mg/dL in men and ≥6.0 mg/dL in women).

RESULTS

Of all the participants, 12.7% (n = 2256) had hyperuricemia. The age-adjusted mean serum uric acid levels increased significantly with increasing BMI and WC (P for trend <0.001). The adjusted odds ratios (ORs) of hyperuricemia increased as BMI and WC increased in both sexes (P for trend <0.001). General (OR 1.98, 95% confidence interval [CI]: 1.69-2.32) and abdominal (OR 2.21, 95% CI: 1.89-2.58) obesity in men and general (OR 3.26, 95% CI: 2.60-4.09) and abdominal (OR 3.43, 95% CI: 2.69-4.37) obesity in women were associated with higher risks of hyperuricemia. These associations were prominent in women. The association between abdominal obesity and hyperuricemia persisted after additional adjustments for BMI in both sexes. Significant interactions were observed in younger adults and individuals without diabetes mellitus.

CONCLUSION

Increased BMI and WC, and general and abdominal obesity, may be important risk factors for hyperuricemia in both sexes. Women, young adults, and individuals without diabetes mellitus require particular attention to prevent obesity and hyperuricemia.

Uric acid level in climacteric women and its association with clinical and metabolic parameters

Climacteric women often experience unfavorable metabolic changes. Consequently, identifying markers that may contribute to such undesirable changes is imperative. This study aimed to evaluate serum uric acid (UA) concentration and its association with metabolic and clinical parameters in climacteric women. We selected 672 women between 40 and 65 years and performed interviews, biochemical analyses, blood pressure, and anthropometric measurements. UA levels were determined using the enzymatic-colorimetric method. We compared variables according to the quartiles of UA using the Kruskal-Wallis test. The mean UA level was 4.9 ± 1.5 mg/dl, ranging from 2.0 to 11.6 mg/dl. We found that UA levels greater than 4.8 mg/dl were associated with adverse metabolic parameters in climacteric women. For all anthropometric and biochemical variables, we observed significantly better results in women who had lower UA levels (p < 0.05). Similarly, we observed a significant increase in blood pressure, frequency of metabolic syndrome, and cardiovascular risk as UA levels increased (p < 0.05). Our findings showed that climacteric women with high levels of UA were more likely to have adverse metabolic and clinical parameters than those with lower UA levels. Further studies may determine the causal relationship between UA and metabolic changes in climacteric women.

Correlation of elevated serum uric acid with coronary artery disease in Xinjiang, China: A retrospective case-control study

Elevated serum uric acid (SUA) levels are associated with coronary artery disease (CAD). However, whether this association is independent of traditional cardiovascular risk factors remains controversial. Our study aimed to determine the concentration of SUA in the presence and severity of CAD in multi-ethnic patients in Xinjiang, China. For this study, 412 consecutive patients with percutaneous coronary intervention (PCI) and 845 individuals with normal coronary angiograms were included in the study. CAD severity was evaluated using the Gensini score index. The SUA concentrations and the levels of various cardiometabolic risk factors were investigated. We assessed the relationship between SUA levels and other cardiometabolic risk factors. Logistic regression was used to evaluate risk factors for PCI patients. SUA levels were significantly elevated in PCI patients compared to those in control subjects (P < .01). With increased UA levels, we found that the risk factors for CAD increased. SUA concentration had a significant positive relationship with total cholesterol (P < .01), triglycerides (P < .01), low-density lipoprotein cholesterol (P < .01), and creatinine (P < .01) in both sexes. In the PCI group, there was no significant correlation between UA levels. SUA levels are not an independent risk factor for CAD. It can be concluded that in Xinjiang, China, SUA is related to multiple risk factors for CAD, but not related to the severity of CAD.

Impact of thyroid cancer on the cancer risk in patients with non-alcoholic fatty liver disease or dyslipidemia

The raised prevalence of obesity has increased the incidence of obesity-related metabolic diseases such as dyslipidemia (DL) and non-alcoholic fatty liver disease (NAFLD), along with the development and progression of various types of cancer, including thyroid cancer. In this study, we investigated whether thyroid cancer in patients with DL and NAFLD could be a risk factor for other cancers. To achieve our goal, we generated two independent cohorts from our institution and from the National Health Insurance System in South Korea. Based on the ICD-10 code, we conducted exact matching (1:5 matching) and estimated the overall risk of thyroid cancer for other cancers in patients with DL or NAFLD. Univariate and multivariate analyses showed that the hazard ratio (HR) of thyroid cancer was 2.007 (95% Confidence Interval [CI], 1.597-2.522) and 2.092 (95% CI, 1.546-2.829), respectively in the institutional cohort and 1.329 (95% CI, 1.153-1.533) and 1.301 (95% CI, 1.115-1.517), respectively in the nationwide cohort. Risk analysis revealed a significant increase in the HR in lip, tongue, mouth, lung, bone, joint, soft tissue, skin, brain, male cancers and lymphoma after thyroid cancer occurred. Thyroid cancer in patients with DL or NAFLD might be a valuable factor for predicting the development of other cancers.

Metabolic pathway analysis of hyperuricaemia patients with hyperlipidaemia based on high-throughput mass spectrometry: a case‒control study

BACKGROUND

Both hyperuricaemia and hyperlipidaemia are common metabolic diseases that are closely related to each other, and both are independent risk factors for the development of a variety of diseases. HUA combined with hyperlipidaemia increases the risk of nonalcoholic fatty liver disease and coronary heart disease. This study aimed to investigate the relationship between HUA and hyperlipidaemia and study the metabolic pathway changes in patients with HUA associated with hyperlipidaemia using metabolomics.

METHODS

This was a case‒control study. The prevalence of hyperlipidaemia in HUA patients in the physical examination population of Tianjin Union Medical Centre in 2018 was investigated. Metabolomics analysis was performed on 308 HUA patients and 100 normal controls using Orbitrap mass spectrometry. A further metabolomics study of 30 asymptomatic HUA patients, 30 HUA patients with hyperlipidaemia, and 30 age-and sex-matched healthy controls was conducted. Differential metabolites were obtained from the three groups by orthogonal partial least-squares discrimination analysis, and relevant metabolic pathways changes were analysed using MetaboAnalyst 5.0 software.

RESULTS

The prevalence of hyperlipidaemia in HUA patients was 69.3%. Metabolomic analysis found that compared with the control group, 33 differential metabolites, including arachidonic acid, alanine, aspartate, phenylalanine and tyrosine, were identified in asymptomatic HUA patients. Pathway analysis showed that these changes were mainly related to 3 metabolic pathways, including the alanine, aspartate and glutamate metabolism pathway. Thirty-eight differential metabolites, including linoleic acid, serine, glutamate, and tyrosine, were identified in HUA patients with hyperlipidaemia. Pathway analysis showed that they were mainly related to 7 metabolic pathways, including the linoleic acid metabolism pathway, phenylalanine, tyrosine and tryptophan biosynthesis pathway, and glycine, serine and threonine metabolism pathway.

CONCLUSIONS

Compared to the general population, the HUA population had a higher incidence of hyperlipidaemia. HUA can cause hyperlipidaemia. by affecting the metabolic pathways of linoleic acid metabolism and alanine, aspartate and glutamate metabolism. Fatty liver is closely associated with changes in the biosynthesis pathway of pahenylalanine, tyrosine, and tryptophan in HUA patients with hyperlipidaemia. Changes in the glycine, serine and threonine metabolism pathway in HUA patients with hyperlipidaemia may lead to chronic kidney disease.

The associations between fasting glucose, lipids and uric acid levels strengthen with the decile of uric acid increase and differ by sex

BACKGROUND AND AIM

Serum lipids, glucose and uric acid are well-known risk factors for metabolic syndrome and cardiovascular diseases; however, how serum uric acid levels are associated with fasting glucose and lipid levels remains to be evaluated.

METHODS AND RESULTS

A cross-sectional study was performed in 104,328 males and 74,916 females. Quantile regression analyses were adopted to optimally fit the associations between levels of uric acid, lipids and glucose. Fasting high-density lipoprotein cholesterol (HDL-C) levels were negatively associated with serum uric acid levels; the associations remained stable in males but strengthened in females with increasing uric acid concentrations. Non-HDL-C and triglyceride (TG) levels were positively associated with serum uric acid levels; the associations also strengthened across deciles of uric acid levels from low to high. Fasting glucose levels were positively associated with uric acid levels in both sexes except in males in the 1st and 2nd deciles of uric acid concentrations; the association coefficients for females were higher than coefficients in males in each decile of uric acid levels. All associations had distinguishable patterns by sex except non-HDL-C, which was associated with uric acid levels with relatively similar trends between sexes. Adjustment for known confounding factors only slightly altered the above associations.

CONCLUSIONS

Fasting serum uric acid levels are associated with fasting levels of HDL-C, non-HDL-C, TG and glucose; the associations strengthened with the deciles of uric acid increase and displayed non-negligible sex differences.

Association between dyslipidaemia and the risk of hyperuricaemia: a six-year longitudinal cohort study of elderly individuals in China

BACKGROUND

Despite abundant evidence linking dyslipidaemia to an increased risk of hyperuricaemia, the exact association between each component of dyslipidaemia and hyperuricaemia remains controversial. Thus, the objective of this research was to examine the correlation between dyslipidaemia and its components, as well as hyperuricaemia in Chinese people over the age of 60.

METHODS

In this study, 4018 participants over 60 years without hyperuricaemia were investigated from 2014 to 2020. The association between each dyslipidaemia component and hyperuricaemia was evaluated employing Cox proportional hazards models. This research conducted further stratified and sensitivity analyses to assess the potential relationship.

RESULTS

A total of 1155 participants suffered from hyperuricaemia (28.75%) at the time of the 6-year follow-up survey. In multivariable-adjusted analyses, compared to participants with normal lipid levels, those with dyslipidaemia had 1.28 times the risk (95% confidence interval 1.12 to 1.47) of experiencing hyperuricaemia. The hazard ratios (HR) (95% CI) comparing high TC, high TG, high LDL-C, and low HDL-C of dyslipidaemia with the regular group were 0.99 (0.72 to 1.37), 1.30 (1.07 to 1.57), 1.02 (0.70 to 1.50), and 1.20 (1.00 to 1.44), respectively. There was a nonlinear dose-response between TG, HDL-C, and serum uric acid (SUA).

CONCLUSIONS

Dyslipidaemia and its two distinct types, high TG and low HDL-C, increased hyperuricaemia incidence in this prospective cohort. Further research should be undertaken to investigate the possible reverse causality between different components of dyslipidaemia and hyperuricaemia.

Association between nocturnal sleep duration and the risk of hyperuricemia among Chinese government employees: A cross-sectional study

Objectives

Evidence has shown that nocturnal sleep duration is associated with the risk of hyperuricemia, yet the findings are inconsistent. Thus, we aimed at exploring the association between nocturnal sleep duration and the risk of hyperuricemia in Chinese government employees.

Methods

A total of 10,321 government employees aged 20-60 years were collected from the Cohort Study on Chronic Diseases among Government Employees in Hunan Province, China. Sleep duration was self-reported. And serum uric acid levels >420 μmol/L in men and >360 μmol/L in women were considered hyperuricemia. The association between nocturnal sleep duration and hyperuricemia risk was examined utilizing multivariate logistic regression models. To further examine the connection between nocturnal sleep duration and serum uric acid levels, multiple linear regression analyses were utilized.

Results

The prevalence of hyperuricemia was 17.2%. The results of logistic regression demonstrated that, in contrast to participants whose sleep duration was 7-8 h, those who slept for <7 h had an elevated risk of hyperuricemia (OR = 1.343, 95%CI: 1.126, 1.601). Further stratified analysis revealed that this association was still observed in those without obesity (OR = 1.365; 95%CI: 1.127, 1.655), hypertension (OR = 1.290, 95%CI: 1.054, 1.578), or diabetes mellitus (OR = 1.361, 95%CI: 1.136, 1.631). Multiple linear regression showed that shorter sleep duration (< 7 h) was positively correlated with serum uric acid levels. In comparison to individuals who slept for 7-8 h, those with sleep duration of fewer than 7 h had serum uric acid levels that were 7.231 μmol/L (95% CI: 2.875, 11.588) higher.

Conclusion

Short nocturnal sleep duration (< 7 h) was associated with a higher risk of hyperuricemia, especially in participants without obesity, hypertension, or diabetes mellitus. Besides, short nocturnal sleep duration was related to greater uric acid levels.

Prevalence and factors related to hypouricemia and hyperuricemia in schoolchildren: results of a large-scale cross-sectional population-based study conducted in Japan

Hypouricemia in children including renal hypouricemia, which is a major cause of exercise-induced acute renal injury (EIAKI), is an important clinical problem, in addition to hyperuricemia. However, no large-scale studies of serum uric acid (UA) concentrations in the general pre-adolescent population have been carried out. We conducted a population-based cross-sectional study to measure the prevalences of hypouricemia and hyperuricemia and identify the associated factors. We analyzed 31,822 (16,205 boys and 15,617 girls) 9-10-year-old children who underwent pediatric health check-ups in Kagawa prefecture between 2014 and 2018. Hypouricemia and hyperuricemia were defined using serum UA concentrations of ≤ 2.0 mg/dL and ≥ 6.0 mg/dL, respectively. The prevalence of hypouricemia was 0.38% in both 9- and 10-year-old boys and girls, and was not significantly associated with age, sex, or environmental factors, including overweight. The prevalence of hyperuricemia was significantly higher in boys (2.7%) than in girls (1.9%), and was significantly associated with age, overweight, future diabetes risk, hypertriglyceridemia, low high-density lipoprotein-cholesterol, and liver damage, but not with high low-density lipoprotein cholesterol. Therefore, some pre-adolescent children in the general population in Japan showed hypouricemia. A means of identifying children with hypouricemia and lifestyle guidance measures for the prevention of EIAKI should be established.

Prevalence and risk factors of hyperuricaemia in non-obese Chinese: a single-centre cross-sectional study

OBJECTIVES

Hyperuricaemia is closely related to metabolic diseases and is receiving increasing attention from all over the world. This study aimed to investigate the prevalence and factors associated with hyperuricaemia in non-obese Chinese population.

DESIGN

Retrospective cross-sectional study.

SETTING

A large general hospital that can provide health check-ups in Hangzhou, China.

PARTICIPANTS

A total of 5731 apparently healthy Chinese adults (2349 men and 3382 women) who took their health check-ups during the year of 2019.

EXCLUSION CRITERIA

(1) those with body mass index ≥24 kg/m2; (2) those with incomplete anthropometric and biochemical data; (3) those with a history of malignancy and (4) those under urate-lowering treatment.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence and factors associated with hyperuricaemia in non-obese Chinese adults.

RESULTS

Of the 5731 non-obese subjects enrolled, 538 (9.4%) were identified as having hyperuricaemia, specifically 16.3% in men and 4.6% in women. The prevalence of hyperuricaemia markedly increased in women aged above 50 years. The prevalence of hyperuricaemia was significantly higher in metabolically unhealthy participants with normal weight than in metabolically healthy participants with normal weight. Participants with hyperuricaemia showed a higher prevalence of metabolic syndrome and fatty liver disease than participants with normouraemia. Age, waist circumference, estimated glomerular filtration rate, blood urea nitrogen, excessive drinking and fatty liver were associated with hyperuricaemia in both genders.

CONCLUSION

The prevalence of hyperuricaemia was 9.4% in non-obese Chinese adults. Non-obese participants with hyperuricaemia also showed multiple metabolic disorders. We suggest that clinicians pay attention to serum uric acid level in non-obese patients.

Angiopoietin-Like Protein 4 May Be an Interplay Between Serum Uric Acid and Triglyceride-Rich Lipoprotein Cholesterol

Background

Although the available evidence has indicated a link between elevated serum uric acid (SUA) level and dyslipidemia, the potential contribution of SUA on lipid profiles remains unclear. Experimental and clinical studies have revealed several mechanisms through which high serum angiopoietin-like protein 4 (ANGPTL4) level exerts deleterious effects on lipid metabolism, but the role of ANGPTL4 in SUA-associated dyslipidemia has not been well studied, so far.

Methods

A total of 80 subjects were classified into high SUA group (n = 40) and low SUA group (n = 40) by the median value of SUA in the whole study population. Serum ANGPTL4 levels were determined by enzyme-linked immunosorbent assays.

Results

In our study, we observed that not only serum triglyceride level [1.03 (0.78, 1.50) mmol/L vs. 1.59 (1.18, 2.37) mmol/L, p = 0.001] but also serum triglyceride-rich lipoprotein cholesterol (TRL-C) level [0.38 (0.32, 0.45) mmol/L vs. 0.46 (0.34, 0.54) mmol/L, p = 0.012] were significantly elevated in high SUA group. Additionally, serum ANGPTL4 in high SUA group was higher than in low SUA group [15.81 (11.88, 20.82) ng/ml vs. 22.13 (17.88, 32.09) ng/ml, p = 0.000]. Moreover, in all subjects, TRL-C levels were positively associated with SUA (r = 0.26, p = 0.023, n = 80) and ANGPTL4 levels (r = 0.24, p = 0.036, n = 80). Using stepwise multiple regression analysis to adjust for potential confounders, SUA was discovered to be an independent contributor to serum ANGPTL4 (p = 0.023). At the same time, serum ANGPTL4 was an independent contributor to the level of TRL-C (p = 0.000). However, the correlation between SUA and TRL-C disappeared after controlling for ANGPTL4 level.

Conclusion

Serum uric acid was positively correlated to TRL-C. ANGPTL4 may be an interplay between SUA and associated elevation of TRL-C.

Serum Uric Acid Levels and Cardiometabolic Profile in Middle-Aged, Treatment-Naïve Hypertensive Patients

INTRODUCTION

Uric acid (UA) is a risk factor associated with cardiometabolic diseases. However, the appropriate threshold of UA remains a matter of controversy.

AIM

To assess whether slightly increased UA levels have any significance in middle-aged, treatment-naïve persons with new-onset hypertension.

METHODS

In this cross-sectional study we recruited middle-aged participants with new-onset hypertension who were treatment-naïve. Subjects below (Group 1) and above the median UA levels (Group 2) were compared regarding clinical and laboratory characteristics that are implicated in cardiovascular and renal risk. The study population consisted of 369 persons (mean age 48.4±10 years) with median UA of 4.8 mg/dl. Group 2 individuals were predominantly male and had higher levels of blood pressure, increased body mass index, waist circumference, and a greater degree of insulin resistance. Additionally, greater lipid profile abnormalities were detected. This group also exhibited a significantly decreased fractional excretion of UA. Multivariate analysis demonstrated that serum UA levels were correlated with male sex, waist circumference, estimated glomerular filtration rate (eGFR), serum calcium and insulin levels, as well as with fractional excretion of UA. A positive association between serum UA levels and the number diagnostic criteria of the metabolic syndrome (MtS) was also noticed. After reclassification of subjects according to UA quartiles, individuals with UA levels ≥ 3.8 mg/dl had significantly higher odds (2.5-fold to 9.8-fold) of having MtS after adjustment of age, sex, and eGFR.

CONCLUSIONS

Uric acid levels in middle-aged, treatment-naïve hypertensive patients are correlated with risk factors for cardiovascular and renal disease.

Association between Gout and Dyslipidemia: A Nested Case-Control Study Using a National Health Screening Cohort

The association between lipid levels and uric acid disorders remains controversial. We evaluated the association between dyslipidemia and gout in a large cohort from the Korean National Health Insurance Service-Health Screening Cohort. Among the 514,866 participants aged ≥40 years, 16,679 gout participants were selected and matched with 66,716 control participants for income, region of residence, sex, and age. We used the ICD-10 codes to define dyslipidemia (E78) and gout (M10) and diagnosis was confirmed when each was reported ≥2 times. The odds ratios (ORs) of dyslipidemia history were calculated using conditional logistic regression in crude, partial, and fully adjusted models. The days of statin use, systolic and diastolic blood pressure, fasting glucose level, total cholesterol, obesity, Charlson comorbidity index, alcohol consumption, and smoking were used as covariates. Patients with gout had a significantly higher dyslipidemia history than those without gout (33.1% vs. 24.0%, p < 0.001). The association was significant after adjustment (OR in partial adjusted model = 1.50, 95% confidence interval (CI) = 1.44−1.57; OR in fully adjusted model = 1.43, 95% CI = 1.37−1.49). These findings were consistent with the subgroup analysis. Our findings suggest that dyslipidemia history is more likely in patients with gout aged ≥40 years than in healthy controls among Korean population.

The dose-response relationship of serum uric acid with Dyslipidaemia and its components: a cross-sectional study of a Chinese multi-ethnic cohort

BACKGROUND

The association between serum uric acid (SUA) and the components of dyslipidaemia and their dose-response relationships have not been thoroughly explored. This study assessed the relationship between SUA and each dyslipidaemia component in Dong, Miao, and Bouyei populations in Guizhou by sex and ethnicities and investigated the dose-response relationship.

METHODS

In total, 16,092 participants aged 30-79 years from The China Multi-Ethnic Cohort (CMEC) Study were examined. Multivariable logistic regression models were applied to explore the relationship between SUA and each dyslipidaemia component by sex and three ethnicities. The dose-response associations between SUA and various dyslipidaemias were investigated using restricted cubic spline regression.

RESULTS

After controlling for confounding factors, the SUA level in total participants positively correlated with each dyslipidaemia component, and women had higher odds ratios (ORs) for each dyslipidaemia component than men (P for trend < 0.001). At the SUA level > 6.37 mg/dL, ORs (95% CI) for dyslipidaemia in the Dong, Miao and Bouyei were 2.89 (2.00-4.19), 2.43 (1.70-3.48), and 3.26 (2.23-4.78), respectively. When the SUA concentration increased by 1 mg/dL, the ORs (95% CI) for total dyslipidaemia was 1.31 (1.24-1.37). A positive dose-response but nonlinear association was found between SUA and total dyslipidaemia, high total cholesterol, and low HDL, whereas an inverse U-shaped association was found between SUA and high LDL-C ( P-nonlinear< 0.0001).

CONCLUSION

The SUA level was positively correlated with each dyslipidaemia component in Dong, Miao, and Bouyei adults, and sex and ethnic differences were also found. A nonlinear dose-response relationship was found between SUA levels and dyslipidaemia and its components. Further research is warranted to investigate the causal link between SUA levels and dyslipidaemia incidence.

Prevalence of asymptomatic hyperuricemia and its association with prediabetes, dyslipidemia and subclinical inflammation markers among young healthy adults in Qatar

AIM

The aim of this study is to investigate the prevalence of asymptomatic hyperuricemia in Qatar and to examine its association with changes in markers of dyslipidemia, prediabetes and subclinical inflammation.

METHODS

A cross-sectional study of young adult participants aged 18 - 40 years old devoid of comorbidities collected between 2012 and 2017. Exposure was defined as uric acid level, and outcomes were defined as levels of different blood markers. De-identified data were collected from Qatar Biobank. T-tests, correlation tests and multiple linear regression were all used to investigate the effects of hyperuricemia on blood markers. Statistical analyses were conducted using STATA 16.

RESULTS

The prevalence of asymptomatic hyperuricemia is 21.2% among young adults in Qatar. Differences between hyperuricemic and normouricemic groups were observed using multiple linear regression analysis and found to be statistically and clinically significant after adjusting for age, gender, BMI, smoking and exercise. Significant associations were found between uric acid level and HDL-c p = 0.019 (correlation coefficient -0.07 (95% CI [-0.14, -0.01]); c-peptide p = 0.018 (correlation coefficient 0.38 (95% CI [0.06, 0.69]) and monocyte to HDL ratio (MHR) p = 0.026 (correlation coefficient 0.47 (95% CI [0.06, 0.89]).

CONCLUSIONS

Asymptomatic hyperuricemia is prevalent among young adults and associated with markers of prediabetes, dyslipidemia, and subclinical inflammation.

Association Between Serum Uric Acid Level and Carotid Atherosclerosis and Metabolic Syndrome in Patients With Type 2 Diabetes Mellitus

BACKGROUND

Serum uric acid (SUA) is associated with many cardiovascular risk factors, such as metabolic syndrome (MetS) and subclinical atherosclerosis. However, the relationship of SUA with carotid atherosclerosis remains controversial. We aimed to investigate whether elevated SUA levels are associated with a high risk of carotid atherosclerosis and MetS in patients with type 2 diabetes mellitus (T2DM).

METHODS

This cross-sectional study was performed with a sample of 1,947 hospitalized patients with T2DM. Carotid intima-media thickness and carotid artery plaques were measured via Doppler ultrasound.

RESULTS

Uric acid levels were negatively associated with HbA1C, eGFR, and HDL-C (all P < 0.001) and positively associated with WBC, BMI, ACR, creatinine, total cholesterol, triglycerides, LDL-C, systolic blood pressure, and diastolic blood pressure (all P < 0.001). After adjusting for multiple potential confounders, the risks were substantially higher for MetS in the highest quartile of SUA levels (odds ratio: 2.91, 95% confidence interval: 1.54-5.51, P = 0.003 for trend) than in the lowest quartile of SUA levels. Furthermore, a significant increase was observed in the prevalence of overweight/obesity, hypertension, and dyslipidemia across the SUA quartiles independent of confounders. However, no significant association was found between SUA quartile with the presence of carotid atherosclerosis.

CONCLUSIONS

In patients with T2DM, SUA levels were closely associated with MetS and its components but not with carotid atherosclerosis.

Metabolic Factors Mediate the Association Between Serum Uric Acid to Serum Creatinine Ratio and Cardiovascular Disease

Background

The serum uric acid/serum creatinine ratio (SUA/SCr), which represents renal function‐normalized SUA, is associated with diverse adverse outcomes. The aim of this study was to investigate the association between SUA/SCr and cardiovascular disease (CVD), and determine whether and to what extent this association is mediated by cardiometabolic factors.

Methods and Results

This prospective study enrolled 96 378 participants from the Kailuan study without stroke and myocardial infarction at baseline (2006). Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Mediation analyses were conducted to separately explore the mediating effects of cardiometabolic factors on the association between SUA/SCr and CVD. During median follow up of 11.01 years, 6315 (6.55%) individuals developed incident CVD. After adjustment for potential confounders, the highest quartile of SUA/SCr was associated with the highest risk of CVD (HR, 1.15; 95% CI, 1.07–1.23), stroke (HR, 1.16; 95% CI, 1.07–1.26), ischemic stroke (HR, 1.12; 95% CI, 1.02–1.22), and hemorrhagic stroke (HR, 1.36; 95% CI, 1.11–1.65), but not with myocardial infarction (HR, 1.07; 95% CI, 0.92–1.25). The association was consistent across different degrees of kidney function and glucose tolerance statuses. Additionally, the association between high SUA/SCr and CVD was partially mediated by triglycerides (30.74%), body mass index (BMI) (19.52%), total cholesterol (15.06%), hs‐CRP (high‐sensitivity C‐reactive protein) (13.06%), diastolic blood pressure (11.75%), and blood glucose (−16.38%).

Conclusions

SUA/SCr and CVD were positively associated. Furthermore, this association was partially mediated through blood lipids, BMI, blood pressure, hs‐CRP, and blood glucose.

High uric acid levels in overweight and obese children and their relationship with cardiometabolic risk factors: what is missing in this puzzle?

OBJECTIVES

The prevalence of hyperuricemia, a common disorder, has been increasing. Moreover, the association between obesity, serum uric acid levels, and cardiometabolic markers in children is unclear. Therefore, this study aimed to analyze the inter-relationships between these factors in a sample of children aged 6-12 years.

METHODS

We evaluated 764 children and stratified them according to their body mass index (BMI). Blood pressure and uric acid, creatinine, lipid, and glycemic profiles were evaluated, and the estimated glomerular filtration rate (eGFR) and the homeostatic model assessment for insulin resistance (HOMA-IR) index were calculated.

RESULTS

There was a significant linear trend of increasing systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), total cholesterol, low-density lipoprotein cholesterol (LDLc), uric acid, insulin levels, and HOMA-IR index values corresponding with overweight and obese groups; however, high-density lipoprotein cholesterol (HDLc) levels decreased with increasing obesity. The mean creatinine level and eGFR were similar across all BMI groups. Uric acid levels were significantly correlated with BMI (r=0.527), waist circumference (r=0.580), SBP (r=0.497), DBP (r=0.362), TG (r=0.534), total cholesterol (r=0.416), LDLc (r=0.286), HDLc (r=-0.248), insulin (r=0.613), and HOMA-IR index (r=0.607). Multiple regression analyses showed that BMI (B=0.071; SE=0.012; p<0.001), TG (B=0.004; SE=0.001; p<0.001), LDLc (B=0.003; SE=0.001; p=0.006), and insulin (B=0.066; SE=0.007; p<0.001) (R²=0.460) were significant predictors of increased uric acid levels and explained 46% of the variability in uric acid in these children.

CONCLUSIONS

Our findings suggest that overweight or obese children are more likely to have higher uric acid levels. Moreover, several cardiometabolic risk factors were strongly associated with high uric acid levels.

High serum uric acid may associate with the increased risk of colorectal cancer in females: A prospective cohort study

Elevated serum uric acid (SUA) levels have been previously reported to play a role in multiple types of cancers. However, epidemiological studies evaluating SUA levels and colorectal cancer risk remain sparse. This cohort study included 444 462 participants between the ages of 40 and 69 years from the UK Biobank, followed up from 2006 to 2010. Multivariable adjusted Cox regression models were used to estimate hazard ratios (HRs). During a mean follow-up of 6.6 years, 2033 and 855 cases of colon and rectal cancers, respectively, were diagnosed. The multivariable-adjusted HRs for risks of colon cancer in the lowest uric acid categories (≤3.5 mg/dL) compared with the reference groups were 1.31 (95% confidence interval [CI] = 0.75-2.29) in males and 1.26 (95% CI = 1.03-1.55) in females. The HRs in the highest uric acid groups (>8.4 mg/dL) were 1.16 (95% CI = 0.83-1.63) in males and 2.00 (95% CI = 1.02-3.92) in females. The corresponding HRs of rectal cancer in the lowest uric acid groups compared with the reference group were 2.21 (95% CI = 1.15-4.23) in males and 0.98 (95% CI = 0.66-1.45) in females. The HRs in the highest uric acid groups were 1.35 (95% CI = 0.82-2.23) in males and 3.81 (95% CI = 1.38-10.56) in females. In conclusion, SUA showed a U-shaped association with colon cancer risk in both male and female populations. The same pattern was observed in male patients with rectal cancer. However, SUA levels were positively associated with occurrence of rectal cancer in female subjects.

Hyperuricemia and Its Associated Factors Among Adult Staff Members of the Ethiopian Public Health Institute, Ethiopia

Background

Hyperuricemia is related not only to an increased risk of gouty arthritis but also to an increased risk of cardiovascular diseases, resistant hypertension, insulin resistance and progression of type 2 diabetes mellitus. However, to the best of our knowledge, the prevalence of hyperuricemia and its associated factors have rarely been assessed in Ethiopian populations. Therefore, this study aimed to determine the prevalence of hyperuricemia and its associated factors among adult staff members of the Ethiopian Public Health Institute.

Methods

An institution-based cross-sectional study was conducted from July 1 to October 28, 2018. A total of 402 study participants were selected using a simple random sampling technique. An interviewer-administered questionnaire was used to collect the data. A blood sample of approximately 5 mL was collected from each study participant after overnight fasting through standardized methods for biochemical tests, and analyses were carried out with an automated COBAS 6000 analyzer. Data analysis was performed by SPSS version 20 software. The factors associated with the outcome variable were identified by bivariable and multivariable logistic regression analyses, and a p value <0.05 was used to declare statistical significance.

Results

The mean age of the study participants was 37.13±10.5 (mean ± SD), and 51.5% of the participants were male. The overall prevalence of hyperuricemia (>5.7 mg/dL for females and >7 mg/dL for males) was found to be 31.0%. The multivariable logistic analysis revealed that age (AOR=1.59, 95% CI 1.01–2.78), sex (AOR=1.66, 95% CI 1.02–2.70), cigarette smoking (AOR=2.05, 95% CI 1.01–4.19) and serum low-density lipoprotein (LDL) (AOR=1.70, 95% CI 1.01–2.87) were significantly associated with hyperuricemia.

Conclusion

The prevalence of hyperuricemia was relatively high compared to similar studies. Early screening for hyperuricemia in the general population, especially in those who are smokers, of older age and with high serum LDL levels, is vital to control its adverse effects at an early stage.

Noriega L, Tovar A, Alegría-Torres JA. Polymorphisms of the genes ABCG2, SLC22A12 and XDH and their relation with hyperuricemia and hypercholesterolemia in Mexican young adults

Background: Hyperuricemia is a pathological condition associated with risk factors of cardiovascular disease. In this study, three genetic polymorphisms were genotyped as predisposing factors of hyperuricemia. Methods: A total of 860 Mexicans (129 cases and 731 controls) between 18 and 25 years of age were genotyped for the ABCG2 (Q191K),  SLC22A12 (517G>A), and  XDH (518T>C) polymorphisms, as predisposing factors of hyperuricemia. Biochemical parameters were measured by spectrophotometry, while genetic polymorphisms were analyzed by real-time PCR. An analysis of the risk of hyperuricemia in relation to the variables studied was carried out using a logistic regression. Results: Male sex, being overweight or obese, having hypercholesterolemia or having hypertriglyceridemia were factors associated with hyperuricemia ( p ≤ 0.05). The ABCG2 polymorphism was associated with hyperuricemia (OR = 2.43, 95% CI: 1.41-4.17, p = 0.001) and hypercholesterolemia (OR = 4.89, 95% CI: 1.54-15.48, p = 0.003), employing a dominant model, but only in male participants. Conclusions: The ABCG2 (Q191K) polymorphism increases the risk of hyperuricemia and hypercholesterolemia in young Mexican males.

Polymorphisms of the genes ABCG2, SLC22A12 and XDH and their relation with hyperuricemia and hypercholesterolemia in Mexican young adults

Background: Hyperuricemia is a pathological condition associated with risk factors of cardiovascular disease. In this study, three genetic polymorphisms were genotyped as predisposing factors of hyperuricemia. Methods: A total of 860 Mexicans between 18 and 25 years of age were genotyped for the ABCG2 (rs2231142), SLC22A12 (rs476037), and XDH (rs1042039) polymorphisms, as predisposing factors of hyperuricemia. Biochemical parameters were measured by spectrophotometry, while genetic polymorphisms were analyzed by real-time PCR. An analysis of the risk of hyperuricemia in relation to the variables studied was carried out using a logistic regression. Results: Male sex, being overweight or obese, having hypercholesterolemia or having hypertriglyceridemia were factors associated with hyperuricemia ( p ≤ 0.05). The ABCG2 polymorphism was associated with hyperuricemia (OR = 2.43, 95% CI: 1.41-4.17, p = 0.001) and hypercholesterolemia (OR = 4.89, 95% CI: 1.54-15.48, p = 0.003), employing a dominant model, but only in male participants. Conclusions: The ABCG2 (rs2231142) polymorphism increases the risk of hyperuricemia and hypercholesterolemia in young Mexican males.

Comorbidities and factors influencing frequent gout attacks in patients with gout: a cross-sectional study

OBJECTIVES

The objective was to identify the comorbidities of gout, to compare gender difference and independent factors of frequent gout attacks (> 20 times).

METHOD

Demographic, clinical variables, self-reported comorbidities, and biochemical variables (i.e., initial serum uric acid (UA) and UA at visit) were collected in this cross-sectional study. Gout attack times were recorded as ≤ 5, 6-10, 11-20, and > 20. Adjusted odds ratio (OR) and corresponding 95% confidence interval (CI) were calculated to explore the association between selected risk factors and frequent gout attacks.

RESULTS

Six hundred fifty-three gout patients with a mean age of 48.3 ± 15.8 years were included, 84.7% of whom were males. The median gout duration was 6.0 (3.0-12.0) years. The most common comorbidities involved hypertension (166, 25.4%), coronary artery disease (CAD) (67, 10.3%), chronic kidney disease (66, 10.1%), and hyperlipidemia (57, 8.7%). Abnormalities including nephrolithiasis (29.4%), hydronephrosis (3.2%), and gallstones (11.9%) were also found. Although female patients had a longer disease duration and more CAD, they had a lower level of UA, creatine, and C-reactive protein (CRP) but higher high-density lipoprotein cholesterol (HDL-C) (p < 0.05). A positive correlation between UA and triglycerides was found in females (p = 0.039). Patients with renal insufficiency or nephrolithiasis had longer disease duration and more gout attacks (p < 0.001). In multivariable regression analysis, only gout duration (OR = 7.89, p < 0.001) and UA (OR = 1.48, p < 0.001) was independent factors of frequent gout attacks.

CONCLUSIONS

Comorbidity screening involving dyslipidemia is often neglected in gout patients. Gout duration and UA are the risk factors of frequent gout attacks. Key Points • Comorbidities can be overlooked if the screening for lipid levels, cardiovascular disease, and kidney disease is not completed. • There are differences in comorbidities and biochemical findings between male and female patients with gout. • Gout duration and serum uric acid level are independent risk factors of frequent gout attacks.

Associations of Serum Uric Acid with Clustering of Cardiovascular Risk Factors and a 10-Year Atherosclerotic Cardiovascular Disease Risk Score in Jiangsu Adults, China

PURPOSE

The relationship between serum uric acid (SUA) and Chinese characteristic 10-year atherosclerotic cardiovascular disease (ASCVD) risk score has not been well evaluated in Chinese populations. Aims of this cross-sectional study were to describe the correlation between SUA level and clustering of prevalent cardiovascular risk factors (CRFs) including overweight, central obesity, hypertension, diabetes and dyslipidemia, as well as the Chinese 10-year ASCVD risk score in adults from Jiangsu Province located in Eastern China.

PATIENTS AND METHODS

A total of 7700 adults from 12 cities in Jiangsu Province were selected through multi-stage stratified cluster random sampling method in 2015. Face-to-face interviews, physical examinations and laboratory examinations were carried out to collect the information of the participants. Multivariate logistic analysis was used to analyze the relationship between SUA quartiles and various CVD risk factors. The nonlinear analysis was conducted to evaluate the relationship between SUA levels and the China-PAR 10-year ASCVD risk scores.

RESULTS

The prevalence of hyperuricemia was 13.3% in all of the participants. By adjusting potential confounders, significant correlations were found between the SUA level and the overweight, central obesity, hypertension and dyslipidemia in both males and females. The clustering of CRFs was different across SUA quantiles (χ ²=607.685, P<0.001). After Gamma trend test (P < 0.001) and ordered logistic regression analysis, it was found out that with the increase of SUA quantiles, prevalent CRFs gradually gathered in both males and females. Furthermore, sex-specific difference was identified between SUA and 10-year ASCVD risk scores.

CONCLUSION

The accumulation of CRFs increased with elevated SUA levels, whereas it was different between genders in the relationship between SUA and 10-year ASCVD risk scores. Tailored strategies should be taken when it came to males and females in managing SUA.

Association between Lipid Profiles and Serum Urate: A Cross-Sectional Study in Southwestern China

OBJECTIVE

The relationship between lipid profiles and serum urate has not been fully investigated. This study aims to investigate the sex- and age-specific association between lipid profiles and serum urate.

METHODS

This was a cross-sectional study involving 122,351 participants aged 18-99 years from a check-up centre in Southwestern China. Generalized additive models and smooth curve fitting were conducted to explore the association between components of lipid profiles and serum urate. Furthermore, multivariate linear and logistic regression models were also performed.

RESULTS

In generalized additive models, the fitted smoothing curves showed that serum urate fluctuated in a small range with total cholesterol, LDL-C, or HDL-C raising. After adjusting for confounders, the differences in serum urate progressively increased with raising serum triglycerides quartiles. The likelihood (odds ratio, OR) for developing serum urate > 420 μmol/L significantly increased in the highest quartile of triglycerides than in the lowest quartile, in hypertriglyceridemia than in normal triglycerides, and with 1 mmol/L increment in triglycerides in all sex- and age-specific groups. Furthermore, the increased OR (95% confidence interval) was higher in females than in males compared with their respective controls.

CONCLUSIONS

Serum urate and the likelihood for developing serum urate >420 μmol/L increased with triglycerides raising. Females were in a higher likelihood for developing serum urate >420 μmol/L than males with raising triglycerides. With changes in total cholesterol, LDL-C, or HDL-C, serum urate fluctuated in a small range.

Combination of Exercise and Vegetarian Diet: Relationship with High Density-Lipoprotein Cholesterol in Taiwanese Adults Based on MTHFR rs1801133 Polymorphism

We examined the association between high-density lipoprotein cholesterol (HDL-C), and exercise and vegetarian diets, in Taiwanese adults, based on the Methylenetetrahydrofolate reductase (MTHFR) rs1801133 polymorphism. Using regression models, we analyzed historical data collected from 9255 Taiwan Biobank (TWB) participants from 2008 through 2015. Exposure to exercise was associated with higher HDL-C (β = 1.0508 and 1.4011 for GG and GA + AA individuals, respectively), whereas a vegetarian diet was associated with lower HDL-C (β = −6.2793 and −4.6359 for those with GG and GA + AA genotype, respectively). We found an interaction between exercise and diet among GG individuals (p = 0.0101). Compared with no exercise/no vegetarian diet, vegetarian diet/no exercise was associated with a 5.1514 mg/dl reduction in HDL-C among those with GG genotype (β = −5.1514, p < 0.0001) and a 4.8426 mg/dl reduction (β = −4.8426, p < 0.0001) among those with GA + AA genotype. Vegetarian diets in combination with exercise predicted a 6.5552 mg/dl reduction in HDL-C among GG individuals (β = −6.5552) and a 2.8668 mg/dl reduction among GA + AA individuals (p < 0.05). These findings demonstrated that vegetarian diet alone was associated with lower HDL-C, no matter the rs1801133 genotype. However, the inclusion of regular exercise predicted much lower levels among GG individuals, whereas levels among GA + AA individuals were relatively higher.

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.