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