|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2020 | Volume
: 33
| Issue : 2 | Page : 70-73 |
|
Interaction between uric acid and obesity
Hind Sh Ahmed
Al-Mustasiriyah Diabetic Centre, Baghdad, Iraq
| Date of Submission | 01-Oct-2020 |
| Date of Decision | 30-Oct-2020 |
| Date of Acceptance | 20-Nov-2020 |
| Date of Web Publication | 6-Jul-2023 |
Correspondence Address:
Dr. Hind Sh Ahmed
Al-Mustasiriyah Diabetic Centre, Baghdad
Iraq
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/IRJCM.IRJCM_5_21
Background: Hyperuricemia is associated with a diversity of other illnesses comprising increased alcohol and purine-rich food ingestion and obesity. Hyperuricemia is deliberated to be a lifestyle condition interrelated with obesity. Objective: The aspire of this revision was to assess the occurrence of hyperuricemia and its association with obesity among Iraqi adults. Subjects and Methods: Ninety participants with hyperuricemia participated in this study; their ages ranged from 35 to 50 years. They were classified into two groups: obese (n = 45) and nonobese (n = 45) from January 2019 to July 2019 at Medical City Hospital/Baghdad. Results: There was a substantial rise (P < 0.05) in body mass index (BMI), fasting serum glucose (FSG), total cholesterol (TC), triacylglycerol (TAG), and low-density lipoprotein cholesterol, while there was a substantial reduction in serum high-density lipoprotein cholesterol (HDL-C) in obese subjects as paralleled to nonobese. Furthermore, there was an elevation in serum lipid ratios, but they were not significant. A substantial rise in serum uric acid was found in obese subjects as paralleled to nonobese. An elevation in serum uric acid level was found in males as paralleled to females, but it was not substantial. Furthermore, there was a substantial positive correlation between serum uric acid and BMI, waist circumference, waist-to-hip ratio, FSG, TC, TAG, and low-density lipoprotein cholesterol, while there was a significant negative correlation between serum uric acid and HDL-C in obese subjects. Conclusions: Outcomes of this data designate a substantial positive correlation between hyperuricemia and obesity among Iraqi adult subjects. Thus, routine measurement of serum uric acid is suggested in obese persons to avoid hyperuricemia and its associated problems.
Keywords: Hyperuricemia, uric acid, obesity, and lipid profile
How to cite this article:
Ahmed HS. Interaction between uric acid and obesity. IRAQI J COMMUNITY MED 2020;33:70-3 |
| Introduction | |  |
Obesity become a worldwide disorder and also has been documented as a hazardous feature with a diversity of medical disorders and contrary health concerns; hyperuricemia is one of these disorders.[1]
Currently, hyperuricemia and obesity with its complications, for example, metabolic syndrome (MS) and cardiovascular diseases (CVD), have higher severe concern for health since their great incidence, well-being significance, and extensive economic problem.[2]
Hyperuricemia may lead to various complications, such as gout, urolithiasis, and nephropathy. The prevalence of hyperuricemia contrasts rendering revisions from various countries.[3]
Uric acid is the end product of purine metabolism, and hyperuricemia increases from the inequity between the production and excretion of uric acid. Serum uric acid is produced in the muscle, liver, and adipose tissue, then it is mainly excreted by renal clearance.[4]
Around 2/3 of serum uric acid is formed endogenously and the residual is a consequence of intake of abundant purines. It is excreted mainly by the kidneys and a lesser part through intestinal and biliary secretion. Defects in serum uric acid metabolism and its diminished excretion by the kidneys are one of the main reasons for hyperuricemia and the progress of gout. An improved exogenous depletion of proteins and endogenous production of uric acid in obese individuals are further influences that lead to hyperuricemia.[5]
Lifestyle features such as obesity, purine-rich diet, and alcohol consumption are important predictors for hyperuricemia progress.[6]
Rendering to epidemiological revisions on MS, serum uric acid was initiated to be certainly related with numerous factors, such as waist circumference (WC), body mass index (BMI), and dyslipidemia.[7],[8] Therefore, hyperuricemia is deliberated to be a public life condition connected to obesity in humans.[5] Numerous epidemiological revisions designated that hyperuricemia is related with a various of diseases comprising obesity, hypertension, MS, dyslipidemia, diabetes mellitus, and CVD.[9],[10],[11] Among these factors, obesity is one of the worldwide health concerns. It affects public health as well as inflicts on the health-care system.[12]
Obese individuals, due to over-calorie intake, get reduced kidney excretion leading to hyperuricemia.[13] Although the causal mechanism of the decreased urate excretion in obese patients and its progress during weight reduction is yet indistinct, hyperuricemia related with obesity can be conserved very well only with suitable diet treatment and in most cases, there is no requirement for drug treatment.[14]
The aspiration of this revision was to assess the occurrence of hyperuricemia and its association with obesity among Iraqi adults.
| Subjects and Methods | | |
Ninety subjects with hyperuricemia participated in this study; their age ranged from 35 to 50 years. They were classified into two groups: obese (n = 45) and nonobese (n = 45) from January 2019 to July 2019 at Medical City Hospital/Baghdad. Individuals with any systemic diseases were excluded from this study. Privacy and confidentiality were considered after verbal consent. Patients were given the right to withdraw from the study at any time.
Anthropometric data were documented such as person height, weight, WC, and waist-to-hip ratio (WHR). Systolic and diastolic blood pressure (SBP, DBP) were assessed. BMI was deliberated as the following formula:
The existence of obesity was assessed by BMI according to the WHO reference.[15] Underweight ≤16.9, normal weight 17–24.9, overweight 25–29.9, and obese ≥30.0.
Fasting serum glucose (FSG), glycated hemoglobin (HbA1c), total cholesterol (TC), triacylglycerol (TAG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and serum uric acid were measured by the manufacturer's protocols (Human Diagnostic, Germany) with a biochemical analyzer.
Diagnostic criteria
Hyperuricemia was definite by a serum uric acid level of ≥7.0 mg/dl in males and ≥6.0 mg/dl in females.
Statistical analysis
The t-test was done to compare between the study groups for baseline parameters. The correlation coefficient (r) among study factors was measured. All values were calculated as means ± standard deviation. A P ≤ 0.05 was dispersed as a numerical meaning.
| Results | | |
The clinical and anthropometric features of the study groups are shown in [Table 1]. A substantial rise (P ≤ 0.05) in age, BMI, WC, WHR, SBP, and DBP was found in obese subjects as paralleled to nonobese.
[Table 2] shows the metabolic factors for patients and controls. There was a substantial rise (P < 0.05) in FSG, TC, TAG, LDL-C, and VLDL while there was a substantial reduction in serum HDL-C in obese subjects as paralleled to nonobese group.
No significant alteration was found in HbA1c between the two groups. There was an elevation in serum lipid ratios, but they were not significant.
[Table 3] shows the serum uric acid in the study groups. There was a substantial rise in serum uric acid in obese subjects as paralleled to nonobese group.
Gender differences in serum uric acid value in the obese group are revealed in [Table 4]. There was an elevation in serum uric acid in males as paralleled to females, but it was not significant.
Furthermore, there was a substantial positive association between serum uric acid and BMI, WC, WHR, FSG, TC, TAG, and LDL-C, while there was a substantial negative association between serum uric acid and serum HDL-C in obese subjects [Table 5]. | Table 5: Correlation coefficients between serum uric acid and other factors in obese subjects
Click here to view |
| Discussion | | |
Currently, hyperuricemia, obesity, and atherosclerosis and its complications, such as CVD, have provoked broad concern for community health because of their high universal occurrence, serious condition significance, and substantial economic burden. Numerous epidemiological revisions have tried to disclose the multifaceted relations among them. Nevertheless, considerable reservations still remain.[16]
This study included a significant increase in clinical and metabolic factors such as BMI, WC, WHR, FSG, TC, TAG, and LDL-C, while HDL-C was significantly decreased in the obese group.
The supposition of the previous revisions relationship between serum uric acid and components of MS and they were similar to current observations.[17],[18]
Similar to the present outcomes, Viazzi et al., in 2013 suggested that a higher level of serum uric acid was related with increased BP in obese subjects.[19]
Research in the nutrition of some revisions has shown that WC is a stronger indicator of a health risk than BMI. Higher WC and BMI are related with insulin resistance and it diminishes uric acid excretion, so elevating its concentration. The mechanism by which serum uric acid is elevated in obese persons is not clear but it has been detected that uric acid is a significant factor in variations in BMI, and serum uric acid concentrations assume weight gain. Hence, it is probable that elevated levels of serum uric acid can be a cause of weight gain rather than the result of it, at least in some cases.[20]
Furthermore, visceral fat accumulation induces a higher inflow of free fatty acids into the liver and hepatic portal vein which triggers the synthesis of TAG followed by a correlated surge in uric acid production through the triggering of the uric acid synthesis pathway.[21]
It has been investigated these relations and has proposed a vital role for hyperuricemia in MS and its constituents. These facts propose the probability of the use of serum uric acid as an interpreter of MS. The outcomes of these revisions deal only with a prognostic correlation between hyperuricemia and MS in obesity. The reason and consequence association between serum uric acid and obesity can only be suggested at this time. Hence, the greater levels of serum uric acid result from the metabolism of purines diet.[22]
Hyperuricemia may happen because of under-excretion, or overproduction, or clustering of these two mechanisms. A study of Opel et al., in 2015 documented that higher uric acid secretion from entire adipose tissue in obese due to purine catabolism in adipose tissue.[23]
Furthermore, You et al., in 2014 suggested a noticeable lessening of renal uric acid excretion in obese individuals and its enhancement by a low-calorie diet.[24]
Pavani et al., in 2018, noticed that though all obese individuals had higher serum uric acid than normal-weight individuals, persons with visceral obesity were interrelated more strictly to overproduction and underexcretion of uric acid.[25]
Accordingly, these revisions donate the hypothesis that both production and excretion of uric acid have a dynamic part in defining of uric acid state. Furthermore, variations in genetics and different lifestyle between populations may also contribute to the results.
The recommended interlinked mechanisms to clarify the connection between serum uric acid and MS were oxidative stress, endothelial dysfunction, renal microvascular lesions, and the inequity in vasodilation due to lessening of nitric oxide and vasoconstriction due to the rise of renin–angiotensin aldosterone–system.[26]
In the current study, a significant positive connection between uric acid and obesity has been found, represented by obesity markers (BMI, WC, and WHR). A similar results could be found in different studies. Furthermore, the association was stronger in males than females in the obese group, which was consistent with findings in different populations such as people from Bangkok, Thailand, middle-age Chinese.[27],[28]
A previous study by Bindler et al., in 2014, documented that males had higher serum uric acid levels than females[29] and the same result had been found in the present study.
Potential mechanisms involved a hormonal influence or sex-based variances in insulin sensitivity and body fat composition. This is supposed to be due to higher levels of estrogen in the plasma of females paralleled to males leading to higher renal clearance of urate by estrogen in females.[30] The current data suggest that men might have a higher risk of hyperuricemia than women.
| Conclusions | | |
Outcomes of these data designate a substantial positive correlation between hyperuricemia and obesity among the Iraqi adult subjects. Thus, routine measurement of serum uric acid is suggested in obese persons to avoid hyperuricemia and its associated problems.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Essa SA, Mishari AK, Kadhom QI. Association between serum uric acid and obesity. J Babylon Univ Pure Appl Sci 2015;2:2015.  |
| 2. | Chen MY, Zhao CC, Li TT, Zhu Y, Yu TP, Bao YQ, et al. Serum uric acid levels are associated with obesity but not cardio-cerebrovascular events in Chinese inpatients with type 2 diabetes. Sci Rep 2017;7:40009. |
| 3. | Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol 2016;213:8-14. |
| 4. | Liu R, Han C, Wu D, Xia X, Gu J, Guan H, et al. Prevalence of hyperuricemia and gout in Mainland China from 2000 to 2014: A systematic review and meta-analysis. Biomed Res Int 2015;2015:762820. |
| 5. | Kanwar G, Kabra R. Serum uric acid level and obesity: An association. Int J Healthc Sci 2016;4:52-5. |
| 6. | Ogura T, Matsuura K, Matsumoto Y, Mimura Y, Kishida M, Otsuka F, et al. Recent trends of hyperuricemia and obesity in Japanese male adolescents, 1991 through 2002. Metabolism 2004;53:448-53. |
| 7. | Tanaka K, Ogata S, Tanaka H, Omura K, Honda C; Osaka Twin Research Group, et al. The relationship between body mass index and uric acid: A study on Japanese adult twins. Environ Health Prev Med 2015;20:347-53. |
| 8. | Wang H, Wang L, Xie R, Dai W, Gao C, Shen P, et al. Association of serum uric acid with body mass index: A cross-sectional study from Jiangsu Province, China. Iran J Public Health 2014;43:1503-9. |
| 9. | Perlstein TS, Gumieniak O, Williams GH, Sparrow D, Vokonas PS, Gaziano M, et al. Uric acid and the development of hypertension: The normative aging study. Hypertension 2006;48:1031-6. |
| 10. | Huda N, Hossain S, Rahman M, Karim MR, Islam K, Mamun AA, et al. Elevated levels of plasma uric acid and its relation to hypertension in arsenic-endemic human individuals in Bangladesh. Toxicol Appl Pharmacol 2014;281:11-8. |
| 11. | Desai RJ, Franklin JM, Spoendlin-Allen J, Solomon DH, Danaei G, Kim SC. An evaluation of longitudinal changes in serum uric acid levels and associated risk of cardio-metabolic events and renal function decline in gout. PLoS One 2018;13:e0193622. |
| 12. | Zhang J, Zhang Y, Deng W, Chen B. Elevated serum uric acid is associated with angiotensinogen in obese patients with untreated hypertension. J Clin Hypertens (Greenwich) 2014;16:569-74. |
| 13. | Alboqai OK, OdehAA, Hourani HM, Al-Qudah F. Obesity and serum uric acid. Bahrain Med Bull 2007;29:88-90. |
| 14. | Yamashita S, Matsuzawa Y, Tokunaga K, Fujioka S, Tarui S. Studies on the impaired metabolism of uric acid in obese subjects: Marked reduction of renal urate excretion and its improvement by a low-calorie diet. Int J Obes 1986;10:255-64. |
| 15. | de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660-7. |
| 16. | Sun D, Li S, Zhang X, Fernandez C, Chen W, Srinivasan SR, et al. Uric acid is associated with metabolic syndromein children and adults in a community: The Bogalusa Heart Study. PLoS One 2014;9:e89696. |
| 17. | Ságodi L, Fehér V, Kiss-Tóth E, Almási A, Barkai L. Metabolic complications of obesity during adolescence, particularly regarding elevated uric acid levels. Orv Hetil 2015;156:888-95. |
| 18. | Li P, Jiang R, Li L, Liu C, Yang F, Qiu Y. Prevalence and risk factors of metabolic syndrome in school adolescents of northeast China. J Pediatr Endocrinol Metab 2014;27:525-32. |
| 19. | Viazzi F, Antolini L, Giussani M, Brambilla P, Galbiati S, Mastriani S, et al. Serum uric acid and blood pressure in children at cardiovascular risk. Pediatrics 2013;132:e93-9. |
| 20. | Sivakumar K, Thamarai R, JeyPragatha R. Screening of serum uric acid in obese individuals in rural population. Int J Sci Study 2014;2:1-4. |
| 21. | Lu N, Dubreuil M, Zhang Y, Neogi T, Rai SK, Ascherio A, et al. Gout and the risk of Alzheimer's disease: A population-based, BMI-matched cohort study. Ann Rheum Dis 2016;75:547-51. |
| 22. | Koborová I, Gurecká R, Hlavatá A, Šebeková K. Association between asymptomatic hyperuricaemia and metabolic syndrome in the adolescents. Vnitr Lek 2015;61:42-9. |
| 23. | Opel N, Redlich R, Grotegerd D, Dohm K, Heindel W, Kugel H, et al. Obesity and major depression: Body-mass index (BMI) is associated with a severe course of disease and specific neurostructural alterations. Psychoneuroendocrinology 2015;51:219-26. |
| 24. | You L, Liu A, Wuyun G, Wu H, Wang P. Prevalence of hyperuricemia and the relationship between serum uric acid and metabolic syndrome in the Asian Mongolian area. J Atheroscler Thromb 2014;21:355-65. |
| 25. | Pavani B, Mohanty S, Dharwadkar A. Hypouricemia in type 2 diabetes mellitus without nephropathy: A case control study. Int J Clin Biochem Res 2018;5:201-5. |
| 26. | Oberbach A, Neuhaus J, Jehmlich N, Schlichting N, Heinrich M, Kullnick Y, et al. A global proteome approach in uric acid stimulated human aortic endothelial cells revealed regulation of multiple major cellular pathways. Int J Cardiol 2014;176:746-52. |
| 27. | Jaipakdee J, Jiamjarasrangsri W, Lohsoonthorn V, Lertmaharit S. Prevalence of metabolic syndrome and its association with serum uric acid levels in Bangkok Thailand. Southeast Asian J Trop Med Public Health 2013;44:512-22. |
| 28. | Yin X, Zhou J, Yu D, Pan Q, Dong X, Zheng F, et al. The correlation between serum uric acid level and abdominal obesity or metabolic syndrome. Zhonghua Nei Ke Za Zhi 2014;53:13-8. |
| 29. | Bindler RC, Daratha KB, Bindler RJ, Short R. Serum uric acid: Relationships with biomarkers in adolescents and changes over 1 year. J Pediatr Endocrinol Metab 2014;27:467-73. |
| 30. | Rochlani Y, Pothineni NV, Mehta JL. Metabolic syndrome: Does it differ between women and men? Cardiovasc Drugs Ther 2015;29:329-38. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
|
Search Pubmed for