Relationship between serum uric acid levels and metabolic syndrome in Chinese postmenopausal women

Comparative analysis of anthropometric indices with serum uric acid in Iranian healthy population

BACKGROUND

The relationship between elevated serum uric acid (SUA) levels and hypertension, metabolic syndrome and cardiovascular disease has been established. In this study, the relation of SUA levels to anthropometric indices, blood cell count and lipid profile was examined.

METHODS

Anthropometric parameters including body-mass index, waist circumference, waist to height ratio, waist to hip ratio, waist to pelvic ratio, neck circumference (NC), body fat mass (BFM), basal metabolic rate (BMR), visceral fat level (VFL) and percent body fat (PBF), along with complete blood cell count, lipid profile and SUA were obtained from 2921 young and middle-aged Iranian healthy subjects. To assess the normality of data, the Kolmogorov-Smirnov test was used. Mann-Whitney, Kruskal-Wallis, Chi-square and Spearman correlation tests were used for evaluating the association between variables. Simple and multiple regression analyses were also performed.

RESULTS

The results of data analysis showed all studied factors were correlated with SUA level except VFL, BFM, and platelet-to-lymphocyte ratio. The highest correlation was with NC, BMR, hematocrits (HCT) and triglycerides (TG). The backward method revealed that TG, LDL, HDL, neutrophil, lymphocyte, platelet, HCT, BMR and skinfold fat thickness were factors related to SUA.

CONCLUSIONS

According to the finding of this study, SUA level is related to anthropometric indices, lipid profile and neutrophil to lymphocyte ratio in healthy population. SUA measurement might be advisable to identify those at increased risk of health problems whom might benefit from further evaluation.

Altered glycolysis results in drug-resistant in clinical tumor therapy

Cancer cells undergo metabolic reprogramming, including increased glucose metabolism, fatty acid synthesis and glutamine metabolic rates. These enhancements to three major metabolic pathways are closely associated with glycolysis, which is considered the central component of cancer cell metabolism. Increasing evidence suggests that dysfunctional glycolysis is commonly associated with drug resistance in cancer treatment, and aberrant glycolysis plays a significant role in drug-resistant cancer cells. Studies on the development of drugs targeting these abnormalities have led to improvements in the efficacy of tumor treatment. The present review discusses the changes in glycolysis targets that cause drug resistance in cancer cells, including hexokinase, pyruvate kinase, pyruvate dehydrogenase complex, glucose transporters, and lactate, as well the underlying molecular mechanisms and corresponding novel therapeutic strategies. In addition, the association between increased oxidative phosphorylation and drug resistance is introduced, which is caused by metabolic plasticity. Given that aberrant glycolysis has been identified as a common metabolic feature of drug-resistant tumor cells, targeting glycolysis may be a novel strategy to develop new drugs to benefit patients with drug-resistance.

Differential risk group of developing stroke among older women with gouty arthritis: A latent transition analysis

OBJECTIVE

Gout-related comorbidities are intricate and its clinical features may demonstrate sex difference; however, few studies have evaluated the links between comorbidities and gout in a female population. The objectives of this study were to compare the aggregation and transitive trajectories of comorbidities of gout, and their consequences in female and male gout populations.

METHODS

A prospective cohort study was conducted using data from the Taiwan National Health Insurance Research Database. A female and male gout population were followed up from 2000 to 2009 to identify the comorbidities of cardiovascular disease, hyperlipidemia, hypertension, diabetes mellitus (DM) and chronic kidney disease. The cumulative incidence of stroke from 2000 to 2010 was examined. A latent trajectory analysis was used to determine the transitive trajectories of the comorbidities of gout.

RESULTS

Both female and male patients with gout had five risk cluster transition (CT) phenotypes of comorbidities within 10-year follow-up: CT1 and CT2, with various persistent comorbidities; CT3, with few persistent comorbidities; and CT4 and CT5, with transfer to cluster 1 from other clusters. The female participants in CT2 predominantly experienced DM and were associated with significantly increased risk of developing stroke.

CONCLUSION

Diabetes is a notable risk factor for the development of stroke in female patients with gout. Early assessment and management for the comorbidities of gout, particularly in DM, would effectively reduce future stroke risk in female gout population.

Uric Acid Is Associated With Inflammation, Coronary Microvascular Dysfunction, and Adverse Outcomes in Postmenopausal Women

Uric acid is a risk factor for coronary artery disease in postmenopausal women, but the association with inflammation and coronary endothelial dysfunction (CED) is not well defined. The aim of this study was to determine the relationship of serum uric acid (SUA), inflammatory markers, and CED. In this prospective cohort study, SUA, high-sensitivity C-reactive protein levels, and neutrophil count were measured in 229 postmenopausal women who underwent diagnostic catheterization, were found to have no obstructive coronary artery disease, and underwent coronary microvascular function testing, to measure coronary blood flow response to intracoronary acetylcholine. The average age was 58 years (interquartile range, 52-66 years). Hypertension was present in 48%, type 2 diabetes mellitus in 5.6%, and hyperlipidemia in 61.8%. CED was diagnosed in 59% of postmenopausal women. Mean uric acid level was 4.7±1.3 mg/dL. Postmenopausal women with CED had significantly higher SUA compared with patients without CED (4.9±1.3 versus 4.4±1.3 mg/dL; P=0.02). There was a significant correlation between SUA and percent change in coronary blood flow to acetylcholine (P=0.009), and this correlation persisted in multivariable analysis. SUA levels were significantly associated with increased neutrophil count (P=0.02) and high-sensitivity C-reactive protein levels (P=0.006) among patients with CED, but not among those without CED. SUA is associated with CED in postmenopausal women and may be related to inflammation. These findings link SUA levels to early coronary atherosclerosis in postmenopausal women.

Relationship between cystatin C and metabolic syndrome among Chinese premenopausal and postmenopausal women without recognized chronic kidney disease

OBJECTIVE

Although studies have shown that elevated cystatin C (Cys-C) levels are associated with the risk of metabolic syndrome (MetS) in the general population, few studies have examined the relationship between serum Cys-C levels and MetS, stratified by menopause status, among women in China. Therefore, we conducted this study to assess the relationship between Cys-C levels and MetS in Chinese premenopausal and postmenopausal women.

METHODS

We performed a cross-sectional analysis of the baseline data of 1,428 Chinese community-dwelling women who participated in the annual health checkup. MetS was defined by the updated National Cholesterol Education Program/Adult Treatment Panel III criteria. Binary logistic regression analysis was performed to estimate the association between Cys-C levels and MetS. One-way analysis of variance, followed by posttest for linear trends, was performed to evaluate the relationships between Cys-C levels and the number of MetS components. Ordinal regression analysis was used to determine whether menopause status and MetS components contribute to elevated levels of Cys-C.

RESULTS

The mean level of Cys-C was significantly higher in women with MetS than in those without MetS among both premenopausal and postmenopausal women, showing a progressive increase (P for trend < 0.001) in parallel with the progressive increment in the number of MetS components in all women. Higher Cys-C levels were found to be associated with the presence of MetS after adjusting for age, body mass index, and estimated glomerular filtration rate in all women. The higher odds ratio changed little, even after further adjustment for serum blood nitrogen, total cholesterol, low-density lipoprotein cholesterol, drinking status, and smoking status. Elevated Cys-C level was significantly associated with postmenopause status (P = 0.007), increased waist circumference (P = 0.006), and elevated blood pressure (P = 0.025).

CONCLUSIONS

Higher serum Cys-C levels are positively and independently associated with the presence of MetS in Chinese premenopausal and postmenopausal women. Elevated Cys-C levels are significantly associated with postmenopause status.

The association between the serum levels of uric acid and alanine aminotransferase in a population-based cohort

BACKGROUND & AIMS

Elevated serum uric acid levels reflect and also cause both oxidative stress and insulin resistance and are frequently observed in patients with the metabolic syndrome. A strong association exists between the metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). Therefore, we aimed to test the association between uric acid and elevated alanine aminotransferase (ALT), as a surrogate for NAFLD, using real-world data.

METHODS

Data used for the cross-sectional study were obtained from Maccabi Healthcare System, a 2-million member health maintenance organization in Israel. The population consisted of individuals aged 20-60 years who underwent blood tests for ALT and uric acid between 1997 and 2012. Individuals with secondary liver disease, celiac, and inflammatory bowel-disease were excluded. Subgroup analysis was performed in subjects who were given the diagnosis of fatty liver in their medical records (n = 2628).

RESULTS

The study population included 82,608 people (32.5% men, mean age 43.91 ± 10.15 years). There was a significant positive dose-response association between serum uric acid levels and the rate of elevated serum ALT (P for trend <0.001). In multivariable model, controlling for potential confounders, the association between uric acid and elevated ALT persisted (OR = 2.10, 95% CI 1.93-2.29, for the fourth quartile vs. the first). This association was maintained in all categories of gender and BMI. Similar results were observed among patients diagnosed with fatty liver (OR = 1.77, 1.22-2.57).

CONCLUSIONS

Serum uric acid is independently associated with elevated ALT, as a surrogate for NAFLD, and thus may serve as a serum marker for liver damage and should be further investigated as a risk factor for NAFLD.

Dose-response Relationship of Serum Uric Acid with Metabolic Syndrome and Non-alcoholic Fatty Liver Disease Incidence: A Meta-analysis of Prospective Studies

Emerging evidence has shown that serum uric acid (SUA) elevation might cause metabolic derangements, including metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD); however, magnitude of the risk has not been quantified. We searched PubMed, EMBASE, and ISI databases for relevant studies through 10 May 2015. Prospective studies reporting the risk of SUA elevation on the incidence of MetS/NAFLD were enrolled. Pooled HR of MetS was 1.55 (95%CI: 1.40-1.70) for the highest versus lowest SUA categories, and 1.05 (95%CI: 1.04-1.07) per incremental increased in SUA of 1 mg/dl. The pooled HR of MetS in younger women was higher than age-matched men and older women (1.17 vs. 1.05 and 1.04, respectively, P < 0.05). Individuals in the highest SUA category had a 40% greater risk of disease NAFLD occurrence. Dose-response increment of NAFLD events was 1.03 (95%CI: 1.02-1.05). A positive relationship with a linear trend for SUA elevation with MetS and NAFLD in different genders was examined by a dose-response meta-analysis (P < 0.001).SUA assay is useful in screening metabolic disorders for linear trend between its elevation and MetS/NAFLD incidence. SUA-lowering therapy is a potential strategy for preventing systemic/hepatic metabolic abnormalities.

Relationship between serum uric acid levels and hepatic steatosis in non-obese postmenopausal women

OBJECTIVE

Serum uric acid levels have been reported to be associated with non-alcoholic fatty liver disease (NAFLD). However, very few studies specifically examining the relationship between serum uric acid (SUA) levels and NAFLD in postmenopausal women have been reported in China, especially in postmenopausal women with normal body mass index (BMI) in whom NAFLD is not uncommon.

METHODS

A cross-sectional study was employed of 528 Chinese normal-BMI postmenopausal women (aged 41-79 years) who participated in annual health check-ups. NAFLD is defined as a hepatic steatosis observed on liver ultrasonography in the absence of a second cause. Of all the participants, 121 women were diagnosed with hepatic steatosis (NAFLD group) and the others were without (non-NAFLD group). SUA quartiles were defined as follows: Q1, < 3.8 mg/dl; Q2, 3.8-4.4 mg/dl; Q3, 4.5-5.0 mg/dl; Q4, 5.1-6.0 mg/dl. Stepwise multivariable regression analysis was used to assess the relationships between SUA level and other variables. The association between SUA quartiles and hepatic steatosis was assessed using binary logistic regression.

RESULTS

Compared to the non-NAFLD group, the mean level of SUA was significantly higher in the NAFLD group (p < 0.01). The adjusted odds ratio (95% confidence interval) for the presence of hepatic steatosis in the highest SUA quartile vs. the lowest quartile was 2.774 (1.396-5.513) for all women (p < 0.01) after adjusting for the factors which were independently associated with uric acid level including waist circumference, high blood pressure, blood urea nitrogen, creatinine, γ-glutamyltransferase, and triglycerides. Most estimates changed little after further adjustment for age, metabolic syndrome, drinking status, and smoking status. The presence of hepatic steatosis significantly increased in the third and fourth quartiles of SUA. The prevalence of hepatic steatosis increased gradually with an increasing SUA quartile (p for trend < 0.01).

CONCLUSION

Higher SUA levels even within the normal range are positively and independently associated with the presence of hepatic steatosis in Chinese postmenopausal women with normal BMI.