Metabolic syndrome, diabetes, and hyperuricemia
aShandong Provincial Key Laboratory of Metabolic Diseases, Qingdao Key Laboratory of Common Diseases Gout Laboratory, the Affiliated Hospital of Medical College, Qingdao University, China bDivision of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua cDepartment of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan. Current opinion in rheumatology
(Impact Factor: 4.89).
03/2013; 25(2):210-216. DOI: 10.1097/BOR.0b013e32835d951e
Purpose of review:
To explore the causal relationship between metabolic syndrome, type 2 diabetes and hyperuricemia.
The prevalence of hyperuricemia in male adults with metabolic syndrome was increased and a large difference in prevalence of metabolic syndrome also existed in those with hyperuricemia compared with normouricemia. Even in those with normouricemia, higher serum uric acid levels were associated with metabolic syndrome. Serum uric acid was an independent risk factor for incident diabetes, and evidence showed that the patients with both gout and type 2 diabetes exhibited a mutual inter-dependent effect on higher incidences. Furthermore, obese patients often demonstrated insulin resistance and adipose tissue macrophage with low-grade inflammation, which is suggested to be the major contributor. Although alcohol intake is considered a risk for developing hyperuricemia, moderate alcohol intake showed a lower risk for developing type 2 diabetes and insulin resistance. Hyperinsulinemia reduces renal excretion of uric acid on the proximal tubular of the kidney leading to hyperuricemia, which has deleterious effects on endothelial function and on nitric oxide bioavailability, thus causing hyperinsulinemia.
We found evidence to suggest that insulin resistance plays a potentially key role in the causal relationship between metabolic syndrome, type 2 diabetes and hyperuricemia. Furthermore, it is likely that hyperuricemia and insulin resistance share a bidirectional causal effect.
Available from: Axel Carl Carlsson
- "Gout is associated with several concomitant diseases that may influence the health of the patient with gout (Zhu et al., 2012). Gout is a metabolic disorder; and gout and hyperuricemia are associated with insulin resistance (Nakamura et al., 2014), the metabolic syndrome, and diabetes mellitus (Li et al., 2013). There is also a strong relationship between gout and hyperuricemia with hypertension, and with diuretic treatment (Gibson, 2013; Zhu et al., 2012), especially with thiazide diuretics (Reungjui et al., 2008; Sica et al., 2011). "
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Study of prevalence of gout with concomitant diseases.
Study population included all living persons in Stockholm County, Sweden, on January 1st 2013 (N=2,124,959). A diagnosis of gout was identified during 2013-2014, with information of diabetes mellitus and insulin resistance, hypertension, chronic heart failure, chronic kidney disease, alcohol abuse, and malignancies. Age-adjusted odds ratios (ORs) with 95 % confidence intervals (95% CI) for women and men with gout, using individuals without gout as referents, were calculated.
Age-adjusted odds of co-morbidities among individuals with gout vs. those without gout were: diabetes mellitus and insulin resistance 3.97 (95% CI 3.65-4.31) in women and 1.88 (95% CI 1.78-1.99) in men; hypertension 4.02 (95% CI 3.69-4.37) in women and 3.21 (95% CI 3.06-3.37) in men; chronic heart failure 4.72 (95% CI 4.31-5.19) in women and 2.84 (95% CI 2.66-3.04) in men; chronic kidney disease 2.08 (95% CI 1.50-2.87) in women and 2.39 (95% CI 2.15-2.66) in men; alcohol abuse 8.98 (95% CI 8.15-9.80) in women and 4.38 (95% CI 4.10-4.69) in men; and malignancies 1.32 (95% CI 1.17-1.48) in women and 1.13 (95% CI 1.06-1.21) men.
Gout is a warning sign for concomittant diseases, e.g. alcoholism, diabetes, cardiovascular diseases, and cancer. KEY MESSAGES:.
Available from: Edgar Denova-Gutiérrez
- "Hyperuricemia is the precursor of gout, which is the principal cause of inflammatory arthritis among adult men and older women . Hyperuricemia is furthermore recognized as an independent risk factor for metabolic and cardiorenovascular conditions including metabolic syndrome, type 2 diabetes (T2DM) and insulin resistance [4-7]. In addition, epidemiological evidence suggests that hyperuricemia may play a role in epidemics of hypertension and coronary heart disease [8,9]; however, recent evidence suggests no causal association between uric acid and ischemic heart disease and blood pressure . "
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The prevalence of hyperuricemia has doubled worldwide during the last few decades. The substantial increase in sweetened beverage (SB) consumption has also coincided with the secular trend of hyperuricemia. Recent studies do show that the consumption of SB can induce hyperuricemia. However, the association between SB and hyperuricemia remains unclear. The aim of this study was to evaluate the association between SB consumption and levels of uric acid in Mexican adults.
We performed a cross-sectional analysis of data from selected adults participating in the baseline assessment of the Health Workers Cohort Study. A total of 6,705 participants of both sexes between ages 18 and 70 years were included. SB intake was estimated using a validated semi-quantitative food frequency questionnaire. Biochemical and anthropometric information was collected using standard procedures. Hyperuricemia was defined as uric acid levels ≥ 7.0 mg/dL in men and ≥ 5.8 mg/dL in women. The association of interest was assessed by multiple logistic regression models.
The odds ratios (OR) for hyperuricemia in men who consume 0.5-1 SB/day was 1.59 (95% CI; 1.05-2.40) and 2.29 (95% CI; 1.55-3.38) for those who consume ≥3 SB/day when compared to men who consume less than half a SB/day. In women, the OR for hyperuricemia for those who consume >1.0- < 3.0 SB/day was 1.33 (95% CI; 1.04-1.70) and 1.35 (95% CI; 1.04-1.75) for those who consume ≥3 SB/day when compared to women who consume less than half a SB/day, independent of other covariables. Men and women with high SB consumption and a body mass index (BMI) ≥ 25 Kg/m2 had greater risk for hyperuricemia than men and women with low SB consumption and normal BMI < 25 Kg/m2.
Our findings suggest that the consumption of SB is associated with an increased risk of hyperuricemia in Mexican adults. However, longitudinal research is needed to confirm the association between SB intake and hyperuricemia.
Available from: Svetlana A Shal'nova, Shalnova
- "Результаты недавнего исследования, представленного Lie и соавт. (2013) подтверждают предположение о том, что инсулинорезистентность играет важную роль в причинно-следственной связи между МС и ГУ  . Более того, некоторые авторы высказывают «пионерское» предположение, что уровень МК не только ассоциируется с сопутствующим действием инсулина, артериального давления и липидных показателей, но и может предсказать снижение чувствительности к инсулину и возникновение сахарного диабета 2 типа в буду- щем  . "
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