Elsevier

Clinica Chimica Acta

Volume 480, May 2018, Pages 119-125
Clinica Chimica Acta

Sex-specific associations of serum uric acid with metabolic syndrome in Chinese rural population: The RuralDiab study

https://doi.org/10.1016/j.cca.2018.02.003Get rights and content

Highlights

  • The research is focused on rural population.

  • The study is combined epidemiological research and meta-analysis.

  • Serum uric acid concentration was positively correlated with the metabolic syndrome after adjusting for a wide range of related risk factors.

  • Evidence on dose-response relationship between serum uric acid and metabolic syndrome was found in this research.

Abstract

Background

We explored the association between serum uric acid (SUA) and metabolic syndrome (MetS) in Chinese rural adults.

Methods

A total of 16,577 subjects (6354 men and 10,223 women) were from the RuralDiab study. SUA concentration was measured by the enzymatic colorimetric method. A meta-analysis including 12 eligible studies focused on SUA and MetS was preformed to confirm the findings of the cross-sectional study.

Results

After adjustment for age, educational level, and other covariates, the odds ratio (ORs) for MetS increased smoothly with the increasing SUA concentration in both sexes (P for no-linear trend > 0.05). The adjusted ORs of MetS comparing the fourth and firstly quartiles were 3.11 [95% CI: 2.58–3.74] in men and 3.64 [95% CI: 3.22–4.11] in women (Ptrend < 0.001). In continuous analysis, each 1 mg/dl increment in SUA concentration was significantly associated with a 41% increased risk of MetS in men and 62% in women. The meta-analysis validated the positive association between SUA and MetS (pooled OR: Men, 1.80 [95% CI: 1.57–2.07]; Women, 2.46 [95% CI: 1.95–3.12]).

Conclusion

SUA concentration was positively with the prevalence of MetS in Chinese rural population, and more studies are needed to explore the mechanisms of the relationship.

What is already known on this topic?

Previous studies have explored the association between serum uric acid and metabolic syndrome, but evidence on the strength and consistency of the association remains uncertain and limited, especially in rural population. In addition, the epidemiological research and meta-analysis on the association have not been reported.

What does this study add?

The results of this study showed that serum uric acid was significantly associated with metabolic syndrome and its components in Chinese rural population. Furthermore, the findings demonstrated that the significant associations varied across sex. In addition, the results of epidemiological research were similar with the meta-analysis, which demonstrates the credible of the results of the epidemiology research.

Introduction

Metabolic syndrome (MetS), a highly prevalent condition throughout the world, is characterized by a clustering of several cardiovascular risk factors including abdominal obesity, hyperglycemia, dyslipidemia, and high blood pressure. Previous study has suggested that insulin resistance plays a key role in the pathophysiologic abnormality of this condition [1]. MetS is a well-established risk factor for cardiovascular diseases, diabetes, and renal diseases [2,3], as well as an important predictor of cardiovascular disease mortality and all-cause mortality [4,5].

Serum uric acid (SUA), the final breakdown enzymatic product of purine metabolism, is widely associated with a variety of diseases including MetS [[6], [7], [8]]. Some prospective studies and a recent meta-analysis conducted in 2015 [9,10] indicated that SUA concentrations were associated with the risk of MetS. Previous experimental studies demonstrated that SUA was found to be associated with insulin resistance [11,12]. Evidence shown that SUA might regulate critical proinflammatory pathways in vascular smooth muscle cell and play a key role in fructose-induce MetS [13,14]. Moreover, hyperuricemia has also been regarded as an important component of MetS [15].

Since hyperuricemia is common in Chinese population, and the prevalence in rural is getting close to that in cities, the public health importance of hyperuricemia or high SUA concentrations as a possible MetS risk factor should not be ignored [16,17]. Although positive association between SUA and MetS was found in the previous studies, limited data is available on the association between SUA and MetS in Chinese rural population based on a large sample. In this study, we used the data from the Rural Diabetes, Obesity and Lifestyle (RuralDiab) study including 19,145 subjects to evaluate the association between SUA and MetS. In addition, a meta-analysis including 12 studies was preformed to compare the results of the cross-sectional study.

Section snippets

Study subjects

During the baseline examination from July 2015 to September 2016, a total of 19,145 subjects aged 18–94 y were recruited in the RuralDiab study, which was registered before the onset of patient enrollment in Chinese Clinical Trial Register. The prevalence of MetS was more common on middle-aged or elder population. In another aspect, the proportion of those aged <35 y was small (5.22% in total population) in the RuralDiab study. Then, the present study only included subjects aged 35–74 y (n

Statistical analysis

All statistical analysis was conducted in the manner of sex independent. Continuous variables were summarized using mean ± SD and the difference of means was compared with t-test. Categorical variables were summarized using numbers (percentages) and the difference of percentages was compared with χ2-test. Logistic regression models were performed to evaluate the association of the SUA quartiles, per 1 mg/dl increment of SUA, or hyperuricemia with risk for MetS. In order to ensure the

Characteristics of study population

A total of 16,577 individuals (6354 men and 10,223 women) were included in the finally analytic samples. The mean SUA concentration was 306.90 ± 77.00 μmol/l in men and 247.49 ± 61.09 μmol/l in women. The characteristics of the study subjects according to with or without MetS are presented in Table 1. Participants with MetS were more likely to be physical inactivity and have higher proportion of family history of hypertension, higher levels of body mass index (BMI), WC, systolic blood pressure

Discussion

In this study, evidence on a positive association between SUA and the prevalence of MetS was found in Chinese rural adults, after adjusting for various potential confounders. The association was more robust in women than in men. In addition, the results of meta-analysis including 12 published studies confirmed the positive association between SUA and MetS. Altogether, the present study strongly supports SUA as an important risk factor for MetS.

Age, some lifestyle factors (smoking, drinking,

Conclusions

In summary, this study reveals that SUA is positively with the prevalence of MetS in Chinese rural population, and the association is robust among women. Increased SUA concentration may be an independent risk factor for MetS. Further studies are needed to confirm these results.

Acknowledgement

The authors thank all of the participants, coordinators, and administrators for their support and help during the research. In addition, the authors would like to thank Dr. Muanda Tsobo Flory, Dr. Fatiha Karam, Dr. Erhui Cai and Prof. Ling Wang for his critical reading of the manuscript. This work was supported by the National Key Research and Development Program of China (Grant NO: 2016YFC0900803), National Natural Science Foundation of China (Grant NO: 81573243, 81602925, U1304821), Henan

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    Honglei Zhang and Yuqian Li contributed equally to this work.

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