High serum uric acid as a novel risk factor for type 2 diabetes: response to Dehghan et al

Serum uric acid and risk of incident diabetes in middle-aged and elderly Chinese adults: prospective cohort study

The association between serum uric acid and the risk of incident diabetes in Chinese adults remains unknown. This study aimed to investigate this association in a community-dwelling population aged ≥ 40 years in Shanghai, China. Oral glucose tole3rance test was conducted during baseline and follow-up visits. Relative risk regression was utilized to examine the associations between baseline gender-specific serum uric acid levels and incident diabetes risk. A total of 613 (10.3%) incident diabetes cases were identified during the follow-up visit after 4.5 years. Fasting plasma glucose, postload glucose, and glycated hemoglobin A1c during the follow-up visit progressively increased across the sex-specific quartiles of serum uric acid (all Ps < 0.05). The incidence rate of diabetes increased across the quartiles of serum uric acid (7.43%, 8.77%, 11.47%, and 13.43%). Multivariate adjusted regression analysis revealed that individuals in the highest quartile had 1.36-fold increased risk of diabetes compared with those in the lowest quartile of serum uric acid (odds ratio (95% confidence interval) = 1.36 (1.06-1.73)). Stratified analysis indicated that the association was only observed in women. Accordingly, serum uric acid was associated with the increased risk of incident diabetes among middle-aged and elderly Chinese women.

The Power of Serum Uric Acid in Predicting Metabolic Syndrome Diminishes With Age in an Elderly Chinese Population

OBJECTIVES

Although serum uric acid (sUA) is not a criterion for diagnosing metabolic syndrome (MetS), many studies have identified a positive association between sUA and MetS in patients of various ages and ethnicities. This association has not been fully established in the very elderly.

DESIGN

Cross-sectional and longitudinal study.

SETTING AND PARTICIPANTS

A total of 18,906 Chinese elderly aged 65 and older undergoing routine health checkups in Taiwan were enrolled.

MEASUREMENTS

Modified Adult Treatment Panel III criteria were used to define MetS. All participants were further divided into nine groups with gender specification according to age (the young-old, 65 to 74; old-old, 75 to 84; and oldest-old, 85 and over) and sUA concentration tertile (males: sUAG1, <5.7 mg/dL; sUAG2, 5.7-6.7 mg/dL; and sUAG3, > 6.7 mg/dL; females: sUAG1, <4.9 mg/dL; sUAG2, 4.9-5.9 mg/dL; and sUAG3, > 5.9 mg/dL). A cross-sectional study was first performed to determine the correlation between sUA and MetS and its components. A longitudinal study then excluded subjects with MetS at baseline to explore the risk of MetS according to sUA levels in 3 age groups.

RESULTS

In the cross-sectional study, we observed a graded, positive association between sUA and MetS components that diminished after age 75. Subjects with higher sUA levels had higher odds ratios (OR) for the occurrence of MetS in the young-old and old-old groups of both sexes (P<0.001) except sUAG2 males in the old-old group. However, the association diminished with age and only a higher OR was observed in sUAG2 males in the oldest-old group (OR, 3.38; 95% CI, 1.11-10.30; P = 0.032). In the longitudinal study, the Kaplan-Meier plot showed that higher sUA levels were associated with a higher risk of MetS in the young-old group of both genders (P < 0.001 sUAG3 vs. sUAG1 and sUAG2). Cox regression analysis further confirmed these results (young-old group: sUAG3 HR, 1.90; 95% CI, 1.42-2.54; P < 0.001; old-old group males: HR, 2.20; 95% CI, 1.04-4.65; P = 0.039; young-old females: HR, 1.83; 95% CI, 1.38 - 2.43; P < 0.001).

CONCLUSIONS

Higher sUA levels in the young-old group of Chinese elderly were associated with a higher risk of developing MetS. sUA levels are thus regarded as a potential tool for early diagnosis of MetS. However, this association diminished in those over 75 years of age.

Serum uric acid is associated with new-onset diabetes in hypertensive patients with left ventricular hypertrophy: The LIFE Study

BACKGROUND

It is unclear whether serum uric acid (SUA) is associated with development of new-onset diabetes (NOD) in patients with hypertension and left ventricular hypertrophy (LVH). The aim of the present investigation was to test the hypothesis that SUA predicts development of NOD in these patients.

METHODS

In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, a double-masked, parallel-group design, 9,193 patients with hypertension and electrocardiographic LVH were randomized to losartan- or atenolol-based antihypertensive treatment and followed for a mean of 4.9 years. At baseline, 7,489 patients with available SUA measurements did not have diabetes mellitus and were thus at risk of its development during the study. We used Cox regression analyses to investigate whether SUA predicted development of NOD.

RESULTS

NOD developed in 522 of 7,489 patients. The association between baseline SUA and development of NOD was significant (hazard ratio (HR) 1.29 per s.d. (1.3 mg/dl), 95% confidence interval (CI) 1.18-1.42, P < 0.001) after adjustment for treatment with losartan vs. atenolol, baseline serum glucose, urinary albumin/creatinine ratio, estimated glomerular filtration rate and Framingham risk score, time-varying systolic and diastolic blood pressure, and time-varying LVH by Cornell voltage-duration product and Sokolow-Lyon voltage. In parallel analyses, baseline quartiles of SUA were significantly associated with increasing NOD (HR 1.28, 95% CI 1.18-1.40, P < 0.001). Time-varying SUA was also associated with NOD (HR 1.10 per s.d. [1.3 mg/dl], 95% CI 1.02-1.19, P = 0.015).

CONCLUSION

Our analysis suggests that SUA is an independent risk marker for NOD in hypertensive patients with LVH.

Serum uric acid and metabolic syndrome in Taiwanese adults

A positive association between serum uric acid and metabolic syndrome has been reported, but little information is available about the association between serum uric acid and metabolic syndrome in Taiwanese adults. The purpose of this study was to investigate the association between serum uric acid levels and metabolic syndrome in Taiwanese adults. We performed a cross-sectional study of 2085 men and 1557 women. All of the participants underwent a health screening during the period from January 2005 to December 2005 at a health center of the Shin Kong Wu Ho-Su Memorial Hospital. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The results showed that hyperuricemia was significantly associated with increased risk for hypertriglyceridemia, low high-density lipoprotein cholesterol level, and high blood pressure in men and women. The risk of metabolic syndrome was significantly higher in the fourth quartile than in the first quartile of uric acid level in men (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.06-2.14) and women (OR, 2.33; 95% CI, 1.39-3.93). In addition, uric acid level was inversely associated with hyperglycemia in men. The ORs of hyperglycemia for the second, third, and fourth quartile of uric acid were 0.69 (95% CI, 0.46-1.03), 0.55 (95% CI, 0.37-0.83), and 0.45 (95% CI, 0.29-0.69), respectively, compared with the lowest quartile of uric acid. The results demonstrate that there is a positive association between serum uric acid levels and metabolic syndrome and an inverse association between uric acid and fasting plasma glucose in Taiwanese adults.