Relationship between hemoglobin and serum uric acid in adults with various glucose metabolism status / 中华预防医学杂志

Objective: To investigate the relationship between hemoglobin and serum uric acid in adults with various glucose metabolism status. Methods: The demographic data and biochemical indicators of the adult population who had received physical examination in the Second Medical Center of the PLA General Hospital from January 2018 to December 2021 were collected. The subjects were divided into two groups according to the level of serum uric acid: the normal uric acid group and the hyperuricemia group. The relationship between hemoglobin (stratified into four levels of Q1 to Q4 by the quartile) and serum uric acid was quantified by using Pearson correlation and logistic regression analysis. The effects of age and glucose metabolism status on the relationship between hemoglobin and serum uric acid were analyzed. Results: A total of 33 183 adults were enrolled with age (50.6±10.0) years. The level of hemoglobin in the normal uric acid group (142.61±14.24) g/L was significantly lower than that in the hyperuricemia group [(151.79±11.24) g/L, P<0.001]. Univariate Pearson correlation analysis showed that hemoglobin was positively associated with serum uric acid (r=0.444, P<0.001). After adjusting for related confounding factors, multivariate logistic regression analysis showed that hemoglobin was associated with serum uric acid, and the OR values (95%CI) of hemoglobin Q2 to Q4 group were 1.29 (1.13-1.48), 1.42 (1.24-1.62) and 1.51 (1.32-1.72), respectively (Ptrend<0.001) when compared with hemoglobin Q1 group. Subgroup analysis and hierarchical interaction analysis suggested that with the increase of hemoglobin, the serum uric acid in the age<60 years subgroup, normal glucose subgroup and prediabetes subgroup increased gradually (Ptrend<0.05 and Pinteraction<0.001). Conclusion: The association between hemoglobin and serum uric acid in adults is affected by age and glucose metabolism status.

Hipertensão arterial e ácido úrico sérico em idosos - estudo SEPHAR III / Arterial hypertension and serum uric acid in elderly- SEPHAR III study

Resumo Fundamento: A hiperuricemia é um achado frequente em pacientes com hipertensão arterial e há evidências cada vez maiores de que essa entidade seja também um fator de risco para doença cardiovascular. Objetivos: No contexto da população em processo de envelhecimento, este estudo tem o objetivo de avaliar níveis de ácido úrico sérico e a prevalência e o controle da hipertensão arterial em um subgrupo da população de adultos romenos (>65 anos), em relação à influência da idade nesses parâmetros. Métodos: A amostra do estudo consiste em 1920 adultos incluídos na pesquisa SEPHAR III, dos quais 447 eram pacientes idosos (>65 anos de idade). Durante as duas visitas do estudo, três aferições de pressão arterial (PA) foram realizadas em intervalos de 1 minuto, e foram realizadas medições de níveis de ácido úrico sérico, função renal por taxa de filtração glomerular, pressão arterial e espessura íntima-média. A hipertensão e os controles foram definidos de acordo com as diretrizes atuais. A avaliação da espessura íntima-média foi determinada pela avaliação por ultrassom Doppler modo B. Um nível de significância p < 0,05 foi adotado para a análise estatística. Resultados: Pacientes adultos tinham níveis de ácido úrico sérico significativamente mais baixos, se comparados a pacientes idosos, independentemente dos níveis de taxa de filtração glomerular. Pacientes adultos tinham níveis de espessura íntima-média, comparados a pacientes idosos. Conclusão: De forma semelhante às pesquisas anteriores, neste estudo, a idade representou um dos fatores contribuintes ao nível aumentado de ácido úrico sérico. Também foi obtido um aumento da prevalência da hipertensão arterial com a idade, com um mau controle da pressão arterial.

Abstract Background: Hyperuricemia is a frequent finding in patients with arterial hypertension, and there is increasing evidence that this entity is also a risk factor for cardiovascular disease. Objective: In the context of an aging population, this study aims to evaluate serum uric acid levels and arterial hypertension prevalence and control in a subgroup of Romanian adults (>65 years), concerning the influence of age on these parameters. Method: The study sample consists of 1,920 adults included in SEPHAR III survey, of whom 447 were elderly patients (>65 years of age). During the two study visits, three blood pressure (BP) measurements were performed at 1-min intervals and serum uric acid levels, kidney function by estimated glomerular filtration rate, blood pressure, and intima media thickness measurements were conducted. Hypertension and controls were defined according to the current guidelines. Intima-media thickness evaluation was assessed by B-mode Doppler ultrasound evaluation. A significance level p < 0.05 was adopted for the statistical analysis. Results: Adult patients had a significant lower serum uric acid levels, compared to elderly patients, regardless of glomerular filtration rate levels. Adult patients showed a significantly lower intima-media thickness levels, when compared to elderly patients. Conclusion: Similar to previous studies, in the present study, age represented one of the factors contributing to the increased level of serum uric acid. An increasing prevalence of arterial hypertension with age, together with a poor control of blood pressure, was also obtained.

Association between hyperuricemia and hypertension: a case-control study

SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between hyperuricemia and systemic arterial hypertension. METHODS: This was a case-control study where individuals aged >18 years were included, who were divided into hypertensive and non-hypertensive groups, excluding those with incomplete information in medical records or with the chronic kidney disease epidemiology collaboration <60 mL/min/1.73 m³. Systemic arterial hypertension was categorized as a dependent variable, while the independent variables were hyperuricemia (i.e., primary variable), sex, education, the practice of physical activity, alcoholism, smoking, diabetes mellitus, chronic kidney disease, a family history of systemic arterial hypertension, age, isolated hyperlipidemia, and mixed hyperlipidemia. Statistical analysis included the univariate and multivariate data analysis, performed by adjusting the logistic regression models using the software R (R Core Team [2018]). RESULTS: Out of 103 patients evaluated, 75 patients were included in this study. In hypertensive patients, hyperuricemia was more frequent (p=0.029), being present in 18.9% individuals. In the univariate analysis, a statistically significant association was found between hyperuricemia and systemic arterial hypertension (OR 10.9; 95%CI 1.29-1420.0; p=0.023); however, in the multivariate analysis, when adjustment was made for age, the only control variable that persisted in the model, this association ceased to be significant (OR 8.5; 95%CI 0.87-1157.0; p=0.070). CONCLUSIONS: There was no independent association between hyperuricemia and systemic arterial hypertension. The latter was associated with diabetes mellitus, chronic kidney disease, and age.

Comportamiento epidemiológico de la hiperuricemia en el Policlínico Universitario Ciro Frías Cabrera, municipio Imías, Guantánamo / Epidemiological behavior of hyperuricemia in the University Polyclinic Ciro Frías Cabrera, municipality of Imías, Guantanamo

Se realizó un estudio descriptivo transversal en el Policlínico Universitario del municipio de Imías "Ciro frías Cabrera", Guantánamo, en el período comprendido de enero a junio de 2017, con el objetivo de caracterizar el comportamiento epidemiológico de la hiperuricemia en la población atendida. Se evaluaron las determinaciones de los valores de referencia de los individuos según sexo y se utilizó el intervalo de la Empresa de Productos Biológicos "Carlos J Finlay". El universo estuvo conformado por 60 pacientes y 48 prestadores (médicos). Predominando el sexo masculino, el grupo etario más significativo fue el de mayor de 30 años, presentándose valores de ácido úrico dentro de los intervalos de referencia en algunos pacientes, sin embargo, estos reflejaban síntomas de gota, relacionada con inadecuada labor educativa y el bajo nivel cognoscitivo e interpretación de los valores de intervalos normados para el diagnóstico de la gota por los prestadores(AU)

A cross-sectional descriptive study was carried out in the Imías "Ciro Frías Cabrera" teaching polyclinic in the period from January to June 2017, with the objective of characterizing the epidemiological behavior of Hyperuricemia in the assisted population. The determinations of the reference values of the individuals according to sex were evaluated and the interval of E.P.B "Carlos J Finlay" was used. The universe consisted of 60 patients and 48 providers (doctors). Predominantly the male sex with 32 people for 53 %, the most significant age group was the one of over 30 years, presenting values of uric acid within the reference intervals in 48 patients, however, these reflected symptoms of gout, related with inadequate educational work and the low level of cognition and interpretation of the values of regulated intervals for the diagnosis of gout by providers(AU)

Critical revision of the medical treatment of gout in Brazil / Revisão crítica do tratamento medicamentoso da gota no Brasil

ABSTRACT Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems.

RESUMO A gota é considerada a forma mais comum de artrite inflamatória em homens acima de 40 anos. Os autores apresentam uma breve revisão sobre o tratamento atual da gota e discutem as limitações farmacológicas existentes no Brasil para o tratamento dessa enfermidade. Apesar de o alopurinol ainda ser a principal medicação para a redução dos níveis de uricemia de pacientes com gota no país, os autores também apresentam dados que apontam para uma grande oportunidade para o mercado farmacológico brasileiro em relação ao tratamento da hiperuricemia e da artrite gotosa e especialmente para pacientes usuários de sistemas privados de saúde e do SUS (Sistema Único de Saúde).

Hiperuricemia y componentes del síndrome metabólico en niños y adolescentes obesos / Hyperuricaemia and metabolic syndrome in obese children and adolescents

Introducción: La hiperuricemia se ha observado como una alteración metabólica adicional en pacientes adultos obesos, pero es poco conocida su magnitud en pacientes pediátricos. Objetivos: Analizar la asociación entre ácido úrico sérico (AUS) con magnitud de la obesidad general y visceral y con otras mediciones bioquímicas en niños y adolescentes obesos de Santiago, Chile. Sujetos y método: En un estudio transversal se evaluaron 770 niños (edades: 6-15 años) de un colegio público de Santiago, Chile, encontrando 227 obesos (29%) (IMC > 2 DE, estándares OMS). Se seleccionaron aleatoriamente 90 niños y aceptaron participar 77, sin otras enfermedades crónicas. Se evaluó: peso, talla, perímetro abdominal, adiposidad visceral con ultrasonografía abdominal y mediciones metabólicas: insulinemia, glucemia (HOMA), lípidos séricos, aspartato aminotransferasa, alanina aminotransferasa (ALT) y AUS. Resultados: Las concentraciones de AUS fueron 0,200 ± 0,065 mmol/l. El AUS fue mayor en niños con valores de hiperinsulinismo (ajustado según edad): 0,221 ± 0,075 vs 0,183 ± 0,054 mmol/l (p < 0,01), sin diferencias según HOMA; las diferencias también se observaron según ALT (> vs < 26 U/ml): 0,238 ± 0,070 vs 0,178 ± 0,054 mmol/l, p < 0,001; la regresión logística controlando por sexo, edad e intensidad de la obesidad mostró solo las ALT asociadas a aumento de AUS. No hubo asociación de mayor AUS con magnitud de IMC, adiposidad visceral o hígado graso. Conclusiones: Los niños y adolescentes obesos de Santiago, Chile, tienen una uricemia mayor en asociación a un aumento de la actividad de la enzima ALT e hiperinsulinismo. Se justifica analizar uricemia en el estudio de niños obesos y en su seguimiento.

Introduction: Hyperuricaemia has been suggested as an additional metabolic factor in adult obese patients, but it has not been sufficiently studied in paediatric. Objectives: To assess the relationship between serum uric acid levels (SUAL) with the level of general and visceral obesity, and other biochemical parameters in children and adolescents of Santiago, Chile. Subjects and method: A cross sectional study was conducted on 770 children and adolescents (ages: 6-15 y.) from a public school in Santiago, Chile, of whom 227 (29%) were obese (BMI > 2 SD, WHO growth standards). Ninety subjects were randomly selected and 77 with no other chronic disease (41 males) accepted to participate. Data was collected on weight, stature, abdominal circumference (AC), visceral adiposity using ultrasound, and other biochemical measurements including fasting glucose, insulin, serum lipids, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and SUAL. Results: The mean SUAL was 0.200 ± 0.065 mmol/L, and was increased in children with hyperinsulinism (adjusted by age: 0.221 ± 0.075 vs 0.183 ± 0.054 mmol/L; P < .01), with no significant differences according to HOMA. Differences were also found between children with ALT > or < 26 U/mL: 0.238 ± 0.070 vs 0.178 ± 0.054 mmol/L, P < .001. The logistic regression showed the increased SUAL was only associated with increased ALT. No significant differences were found in general or visceral adiposity measurements or fatty liver. Conclusions: Children and adolescents from Santiago, Chile have higher uric acid serum uric acid levels as well as an association with increased ALT and insulin. It is demonstrated in this study that uric acid should be measured in obese children and adolescents, and in their follow up.

Relation between uric acid and metabolic syndrome in subjects with cardiometabolic risk / Relação entre ácido úrico e síndrome metabólica em uma população com risco cardiometabólico

Objective To identify possible relations between serum uric acid levels and metabolic syndrome and its components in a population with cardiometabolic risk. Methods This cross-sectional study included 80 subjects (46 women), with mean age of 48±16 years, seen at the Cardiovascular Health Program. Results The prevalence of hyperuricemia and metabolic syndrome was 6.3% and 47.1%, respectively. Uric acid level was significantly higher in individuals with metabolic syndrome (5.1±1.6mg/dL), as compared to those with no syndrome or with pre-syndrome (3.9±1.2 and 4.1±1.3mg/dL, respectively; p<0.05). The uric acid levels were significantly higher in men presenting abdominal obesity, and among women with abdominal obesity, lower HDL-c levels and higher blood pressure (p<0.05). Conclusion Uric acid concentrations were positively related to the occurrence of metabolic syndrome and its components, and there were differences between genders. Our results indicate serum uric acid as a potential biomarker for patients with cardiometabolic risk. .

Objetivo Identificar as possíveis relações da concentração sérica de ácido úrico com a síndrome metabólica e seus componentes em uma população com risco cardiometabólico. Métodos Estudo transversal que incluiu 80 indivíduos (46 mulheres), com média de idade de 48±16 anos, atendidos pelo Programa de Atenção à Saúde Cardiovascular. Resultados As prevalências de hiperuricemia e de síndrome metabólica foram 6,3% e 47,1%, respectivamente. A concentração de ácido úrico foi significantemente maior entre os sujeitos com síndrome metabólica (5,1±1,6mg/dL), comparada a daqueles sem a síndrome ou com pré-síndrome (3,9±1,2 e 4,1±1,3mg/dL, respectivamente; p<0,05). A concentração de ácido úrico foi maior entre homens com obesidade abdominal, e entre mulheres com obesidade abdominal, menores concentrações de HDL-c e maior pressão arterial (p<0,05). Conclusão As concentrações de ácido úrico foram positivamente relacionadas com a ocorrência de síndrome metabólica, bem como de seus componentes, para os quais foram observadas diferenças entre os sexos. Nossos resultados indicam a importância do ácido úrico como biomarcador em pacientes com risco cardiometabólico. .

Serum uric acid and disorders of glucose metabolism: the role of glycosuria

Hyperuricemia has been associated with hypertension, diabetes mellitus, and metabolic syndrome. We studied the association between hyperuricemia and glycemic status in a nonrandomized sample of primary care patients. This was a cross-sectional study of adults ≥20 years old who were members of a community-based health care program. Hyperuricemia was defined as a value >7.0 mg/dL for men and >6.0 mg/dL for women. The sample comprised 720 participants including controls (n=257) and patients who were hypertensive and euglycemic (n=118), prediabetic (n=222), or diabetic (n=123). The mean age was 42.4±12.5 years, 45% were male, and 30% were white. The prevalence of hyperuricemia increased from controls (3.9%) to euglycemic hypertension (7.6%) and prediabetic state (14.0%), with values in prediabetic patients being statistically different from controls. Overall, diabetic patients had an 11.4% prevalence of hyperuricemia, which was also statistically different from controls. Of note, diabetic subjects with glycosuria, who represented 24% of the diabetic participants, had a null prevalence of hyperuricemia, and statistically higher values for fractional excretion of uric acid, Na excretion index, and prevalence of microalbuminuria than those without glycosuria. Participants who were prediabetic or diabetic but without glycosuria had a similarly elevated prevalence of hyperuricemia. In contrast, diabetic patients with glycosuria had a null prevalence of hyperuricemia and excreted more uric acid and Na than diabetic subjects without glycosuria. The findings can be explained by enhanced proximal tubule reabsorption early in the course of dysglycemia that decreases with the ensuing glycosuria at the late stage of the disorder.

Resistência à insulina e componentes da síndrome metabólica, análise por sexo e por fase da adolescência / Insulin resistance and components of metabolic syndrome, analysis by gender and stage of adolescence

Objetivo: Analisar a influência dos componentes da síndrome metabólica na resistência à insulina, por sexo e fase da adolescência. Sujeitos e métodos: Avaliaram-se dados bioquímicos, clínico, de estilo de vida e composição corporal de 800 adolescentes de 10 a 19 anos, de ambos os sexos, de Viçosa-MG/Brasil, divididos em fases: inicial (10 a 13 anos), intermediária (14 a 16 anos) e final (17 a 19 anos). Resultados: 10,3 e 3,4% apresentavam, respectivamente, resistência à insulina e síndrome metabólica. Na fase inicial, observaram-se maior prevalência de dislipidemia e na intermediária, de hiperuricemia e excesso de gordura corporal. O sexo feminino apresentou maior prevalência de dislipidemia, excesso de gordura corporal e resistência à insulina e o masculino, maior prevalência de HDL baixo, hiperuricemia e pressão arterial alterada. Os da fase inicial apresentaram maiores valores de colesterol total, LDL, HDL, triglicerídeos, glicemia de jejum e relação cintura/quadril, ficaram menos tempo sentados e realizavam maior número de refeições (p < 0,05) em relação às outras fases. O modelo final, ajustado por sexo, foi diferente para cada fase da adolescência. Conclusões: A resistência à insulina está associada à inadequação na composição corporal, nos níveis bioquímicos e no estilo de vida, sendo os fatores associados diferentes em cada fase da adolescência. Arq Bras Endocrinol Metab. 2014;58(6):610-8 .

Objective: To analyze the influence of metabolic syndrome components in insulin resistance, by gender and adolescence phase. Subjects and methods: We evaluated biochemical, clinical, lifestyle and body composition data of 800 adolescents from 10 to 19 years old, from both genders, from Viçosa, MG/Brasil, and there was the division by stage: early (10 to 13 years), intermediate (14 to 16 years) and late (17 to 19 years). Results: 10.3 and 3.4% had, respectively, insulin resistance and metabolic syndrome. In the initial phase there was a higher prevalence of dyslipidemia and intermediate hyperuricemia and excess body fat. Females had a higher prevalence of dyslipidemia, excess body fat and insulin resistance and higher male prevalence of low HDL, hyperuricemia and blood pressure changes. Those from the initial phase had higher levels of total cholesterol, LDL, HDL, triglycerides, fasting glucose and waist/hip ratio, stayed less time sitting and had more meals (p < 0.05) in relation to other phases. The final model, adjusted for gender, was different for each phase of adolescence. Conclusions: Insulin resistance is associated with inadequate body composition, in biochemical levels and lifestyle, being the factors associated different in each phase of adolescence. Arq Bras Endocrinol Metab. 2014;58(6):610-8 .

Sweetened beverages intake, hyperuricemia and metabolic syndrome: the Mexico City Diabetes Study / Ingesta de bebidas endulzadas, hiperuricemia y síndrome metabólico: estudio de la Diabetes en la Ciudad de México

Objective. To determine prevalence of hyperuricemia and its relation with intake of sweetened beverages (SB) and metabolic syndrome (MS) in low income urban Mexican population. Materials and methods. A cross-sectional analysis of The Mexico City Diabetes Study, a prospective population-based investigation (1 173 participants) was performed. We used logistic regression, adjusted by pertinent variables. We determined prevalence of hyperuricemia and explored associations of uric acid levels with MS and intake of SB. Results. Prevalence of hyperuricemia was 26.5 and 19.8% in males and females respectively. In an adjusted multivariate model, body mass index, waist circumference, and triglyceride were higher as uric acid quartiles increased (p<0.005-0.001). The odds ratio for MS was 1.48 for 3rd uric acid quartile and 2.03 for 4th quartile. Higher consumption of SB was associated with higher uric acid levels (p<0.001). Conclusion. Prevalence of hyperuricemia is high. Potential association with intake of SB, resulting in metabolic alterations should be considered.

Objetivo. Determinar prevalencia de hiperuricemia en población mexicana urbana de bajos ingresos, relación con ingesta de bebidas endulzadas y síndrome metabólico. Material y métodos. Análisis transversal del Estudio de la Diabetes en la Ciudad de México (1 173 participantes), utilizando regresión logística, ajustada por variables pertinentes. Se determinó prevalencia de hiperuricemia, se exploraron asociaciones de niveles de ácido úrico con síndrome metabólico y bebidas endulzadas. Resultados. La prevalencia de hiperuricemia fue 26.5 y 19.8%, hombres y mujeres, respectivamente. El índice de masa corporal, circunferencia de cintura y triglicéridos fueron más altos con cada cuartil de ácido úrico (p<0.005 - 0.001). La razón de momios para síndrome metabólico fue 1.48 para el tercer cuartil y 2.03 para el cuarto. Se encontró mayor consumo de bebidas endulzadas a mayores niveles de acido úrico (p<0.001). Conclusión. La prevalencia de hiperuricemia es alta. La asociación con bebidas endulzadas y las alteraciones metabólicas resultantes deben considerarse.

Acido úrico, aterosclerosis y calcificaciones vasculares en enfermedad renal crónica / Uric acid, atherosclerosis and vascular calcifications in chronic kidney disease

Estudios clínicos y epidemiológicos han demostrado que la enfermedad cardiovascular está relacionada con un aumento en la tasa de mortalidad en los pacientes con enfermedad renal crónica (ERC). Las complicaciones vasculares son principalmente secundarias a calcificaciones y ateroesclerosis. En los últimos años se ha renovado el interés por la asociación entre niveles de ácido úrico y riesgo cardiovascular. El objetivo de esta investigación fue relacionar la presencia de calcificaciones vasculares (CV) y aterosclerosis, evaluadas mediante ecografía carotídea, con niveles de ácido úrico en pacientes con ERC estadio 5 en diálisis. Se observaron CV en 56% de los pacientes; 46% tuvo criterios ecográficos para aterosclerosis con un promedio general de 0,89 mm (DE: ± 0,28), siendo mayor en los pacientes con hipertensión arterial y diabetes mellitus; este grupo también mostró mayor predisposición para CV (p= 0,01). Los niveles de urea (141,3 mg/dL) (p= 0,01) y ácido úrico (6,9 mg/dL) (p= 0,04) mostraron asociación estadísticamente significativa con la presencia de CV. Los eventos cardiovasculares adversos predominaron en los pacientes con aterosclerosis y CV (p= 0,01). Esta investigación demostró que un incremento en los niveles de ácido úrico por encima de 6 mg/L está relacionado con mayor riesgo de presentar calcificaciones y eventos cardiovasculares adversos en pacientes con ERC.

Epidemiological and clinical studies have shown that cardiovascular disease is associated with an increase in mortality in patients with chronic kidney disease (CKD). Vascular complications are mainly secondary to calcification and atherosclerosis. Interest in the association between uric acid levels and cardiovascular risk has been renewed in recent years. The objective of this research was to determine the relation between vascular calcification (VC) and atherosclerosis, through carotid ultrasound, with uric acid levels in patients with CKD in dialysis. VCs were observed in 56% of patients, 46% had ultrasound criteria for atherosclerosis with an overall average of 0.89 mm (SD ± 0.28), being higher in patients with hypertension and diabetes; this group also showed increased susceptibility to VC (p= 0.01). The levels of urea (141.3 mg/dL) (p= 0.01) and uric acid (6.9 mg/dL) (p= 0.04) showed significant association with the presence of VC. Adverse cardiovascular events were observed mainly in patients with atherosclerosis and VC (p= 0.01). This investigation showed that an increase in uric acid levels above 6 mg/dL is associated with an increased risk of calcification and cardiovascular adverse events in CKD patients in dialysis.

Distribuição por gênero de ácido úrico sérico e fatores de risco cardiovascular: estudo populacional / Gender distribution of serum uric acid and cardiovascular risk factors: population based study / Distribución por género del ácido úrico sérico y factores de riesgo cardiovascular: estudio poblacional

FUNDAMENTO: Não há dados relativos à epidemiologia da hiperuricemia em estudos brasileiros de base populacional. OBJETIVO: Investigar a distribuição de ácido úrico sérico e sua relação com variáveis demográficas e cardiovasculares. MÉTODOS: Estudamos 1.346 indivíduos. A hiperuricemia foi definida como > 6,8 e > 5,4 mg/dL para homens e mulheres, respectivamente. A síndrome metabólica (SM) foi definida utilizando-se os critérios NCEP ATP III. RESULTADOS: A prevalência de hiperuricemia foi de 13,2 por cento. A associação de ácido úrico sérico (AUS) com fatores de risco cardiovasculares foi específica para o gênero: em mulheres, maiores níveis de AUS estiveram associados com IMC elevado, mesmo após ajustes da pressão arterial sistólica para idade (PAS). Em homens, a relação do AUS com o colesterol HDL esteve mediada pelo IMC, enquanto em mulheres, o AUS mostrou-se semelhante e dependente do IMC, independentemente dos níveis glicose e presença de hipertensão. Nos homens, os triglicerídeos, a circunferência abdominal (CA) e a PAS explicaram 11 por cento, 4 por cento e 1 por cento da variabilidade do AUS, respectivamente. Nas mulheres, a circunferência abdominal e os triglicerídeos explicaram 9 por cento e 1 por cento da variabilidade de AUS, respectivamente. Em comparação com o primeiro quartil, homens e mulheres no quarto quartil apresentavam 3,29 e 4,18 vezes mais de aumento de risco de SM, respectivamente. As mulheres apresentaram uma prevalência quase três vezes maior de diabetes melito. Homens normotensos com MS apresentaram maiores níveis de AUS, independente do IMC. CONCLUSÃO: Nossos resultados parecem justificar a necessidade de uma avaliação baseada no gênero em relação à associação do AUS com fatores de risco cardiovasculares, que se mostraram mais acentuados em mulheres. A SM esteve positivamente associada com AUS elevado, independentemente do gênero. A obesidade abdominal e a hipertrigliceridemia foram os principais fatores associados com a hiperuricemia mesmo em indivíduos normotensos, o que pode adicionar maior risco para a hipertensão.

BACKGROUND: There is no data concerning the epidemiology of hyperuricemia in Brazilian population-based studies. OBJECTIVE: To investigate the distribution of serum uric acid and its relationship with demographics and cardiovascular variables. MEHTODS: We studied 1,346 individuals. Hyperuricemia was defined as > 6.8 and > 5.4 mg/dL for men and women, respectively. Metabolic syndrome (MS) was defined with NCEP ATP III criteria. RESULTS: The prevalence of hyperuricemia was 13.2 percent. The association of serum uric acid (SUA) with cardiovascular risk factors was gender-specific: in women, higher SUA was associated with increasing BMI, even after adjustments for age-systolic blood pressure (SBP). In men, the relationship of SUA with HDLc was mediated by BMI, whereas in women, SUA was similar and dependent on BMI, regardless of glucose levels and presence of hypertension. In men, triglycerides, waist circumference (WC) and SBP explained 11 percent, 4 percent and 1 percent of SUA variability, respectively. In women, WC and triglycerides explained 9 percent and 1 percent of SUA variability, respectively. Compared to the first quartile, men and women in the fourth quartile had a 3.29 fold and 4.18 fold increase of MS risk, respectively. Women had almost three fold higher prevalence of diabetes mellitus. Normotensive men with MS presented higher SUA, regardless of BMI. CONCLUSION: Our results seem to justify the need for gender-based evaluation regarding the association of SUA with cardiovascular risk factors, which was more pronounced in women. MS was positively associated with increasing SUA, regardless of gender. Abdominal obesity and hypertriglyceridemia were the main factors associated with hyperuricemia even in normotensive individuals, which may add a higher risk for hypertension.

RFUNDAMENTO: No existen datos relativos a la epidemiología de la hiperuricemia en los estudios brasileros de base poblacional. OBJETIVO: Investigar la distribución del ácido úrico sérico y su relación con las variables demográficas y cardiovasculares. MÉTODOS: Estudiamos 1.346 individuos. La hiperuricemia se definió como > 6,8 y > 5,4 mg/dL para hombres y mujeres, respectivamente. El síndrome metabólico (SM) fue definido utilizando los criterios NCEP ATP III. RESULTADOS: La prevalencia de hiperuricemia fue de un 13,2 por ciento. La asociación del ácido úrico sérico (AUS), con los factores de riesgo cardiovasculares fue específica para el género: en las mujeres, mayores niveles de AUS estuvieron asociados con un IMC elevado, incluso después de los ajustes para la presión arterial sistólica (PAS) y edad . En los hombres, la relación del AUS con el colesterol HDL fue mediada por el IMC, mientras que en las mujeres, el AUS demostró ser parecido y dependiente del IMC, independientemente de los niveles de glucosa y de la presencia de hipertensión. En los hombres, los triglicéridos, la circunferencia abdominal (CA) y la PAS, explicaron el 11 por ciento, 4 por ciento y el 1 por ciento de la variabilidad del AUS, respectivamente. En las mujeres, la circunferencia abdominal y los triglicéridos explicaron el 9 por ciento y el 1 por ciento de la variabilidad de AUS, respectivamente. En comparación con el primer cuartil, los hombres y las mujeres, en el cuarto cuartil, tenían 3,29 y 4,18 veces más aumento de riesgo de SM, respectivamente. Las mujeres tenían una prevalencia casi tres veces mayor de diabetes mellitus. Los hombres normotensos con MS tenían mayores niveles de AUS, independiente del IMC. CONCLUSIONES: Nuestros resultados parecen justificar la necesidad de una evaluación con base en el género, respecto de la asociación del AUS con los factores de riesgo cardiovasculares, que demostraron ser más acentuados en las mujeres. La SM estuvo positivamente asociada con el AUS elevado, independientemente del género. La obesidad abdominal y la hipertrigliceridemia fueron los principales factores asociados con la hiperuricemia incluso en los individuos normotensos, lo que puede añadirle un riesgo mayor a la hipertensión.

Relation of uric acid with components of metabolic syndrome before and after Roux-en-Y gastric bypass in morbidly obese subjects / Relação do ácido úrico com os componentes da síndrome metabólica antes e após o bypass gástrico com reconstrução em Y-de-Roux em pacientes obesos mórbidos

OBJECTIVE: The purpose of the study was to investigate the prevalence of hyperuricemia in morbidly obese subjects before and after Roux-en-Y gastric bypass (RYGBP) and its relationship with metabolic syndrome abnormalities. SUBJECTS AND METHOD: We evaluated 420 morbidly obese patients. Pre and postoperative (8 months after RYGBP) blood samples were drawn. Obese patients underwent laparoscopic RYGBP and after eight months all the tests were repeated. RESULTS: The overall prevalence of hyperuricemia was 34.28 percent. Hyperuricemia was more common in men than in women (51.72 vs. 29.72 percent; p = 0.0002). Men with hyperuricemia were more likely to have diabetes (p = 0.034) and more elevated fasting plasma glucose levels (p = 0.027). Women with hyperuricemia were more likely to have hypertension (p = 0.003), metabolic syndrome (p = 0.001), elevated triglycerides (p = 0.001) and GGT (p = 0.009), and decreased HDL (p = 0.011). After surgery, uric acid levels decreased from 5.60 ± 1.28 to 4.23 ± 1.20 (p < 0.0001). The prevalence of hyperuricemia decreased from 33.6 percent to 6.4 percent (p < 0.0001), in men from 48.3 percent to 17.2 percent (p < 0.0001) and in women from 29.7 percent to 3.6 percent (p < 0.0001). CONCLUSION: Concentrations of uric acid were associated with the prevalence of metabolic abnormalities in this sample of morbidly obese patients. Also, weight loss after RYGBP can reduce uric acid levels and the prevalence of hyperuricemia.

OBJETIVO: O objetivo do estudo foi investigar a prevalência de hiperuricemia em pacientes obesos mórbidos antes e após o bypass gástrico com reconstrução em Y-de-Roux (RYGBP) e sua relação com anormalidades da síndrome metabólica. SUJEITOS E MÉTODOS: Foram avaliados 420 pacientes com obesidade mórbida. Amostras de sangue pré e pós-operatório (8 meses após RYGBP) foram obtidas. Os pacientes obesos foram submetidos a RYGBP laparoscópica e após oito meses todos os testes foram repetidos. RESULTADOS: A prevalência de hiperuricemia foi 34,28 por cento. A hiperuricemia foi mais comum em homens do que em mulheres (51,72 vs. 29,72 por cento, p = 0,0002). Homens com hiperuricemia foram mais propensos a ter diabetes (p = 0,034) e tinham níveis mais elevados de glicemia de jejum (p = 0,027). Mulheres com hiperuricemia foram mais propensas a ter hipertensão arterial (p = 0,003), síndrome metabólica (p = 0,001), triglicérides elevado (p = 0,001) e GGT (p = 0,009) e diminuição de HDL (p = 0,011). Após a cirurgia, os níveis de ácido úrico diminuíram de 5,60 ± 1,28 para 4,23 ± 1,20 (p < 0,0001). A prevalência de hiperuricemia diminuiu 33,6 por cento para 6,4 por cento (p < 0,0001), em homens de 48,3 por cento para 17,2 por cento (p < 0,0001) e nas mulheres de 29,7 por cento para 3,6 por cento (p < 0,0001). CONCLUSÃO: As concentrações de ácido úrico foram associadas com a prevalência de anormalidades metabólicas nesta amostra de pacientes com obesidade mórbida. Além disso, a perda de peso após RYGBP pode reduzir os níveis de ácido úrico e a prevalência de hiperuricemia.

A prevalência de hiperuricemia está aumentada em pacientes ambulatoriais com hiperglicemia e dislipidemia / Prevalence of high serum uric acid is increased in ambulatory subjects with hyperglycemia and dyslipidemia

INTRODUCTION: Serum uric acid has been considered a marker or an element of the clinical and laboratory alterations in the metabolic syndrome. OBJECTIVE: to evaluate the association between levels of serum uric acid (UA) and the following laboratory profile: fasting glucose > 100 mg/dl, triglycerides > 150 mg/dl and high density lipoprotein cholesterol (HDL-C) < 50 mg/dl in women and < 40 mg/dl in men. METHOD: In a cross-sectional survey, blood samples of 4,328 randomized outpatients aged from 20 to 102 years were analyzed. RESULTS: The mean (interquartile range) UA level was higher in men (6.7; 2.4-12.5 mg/dl) and women (5.4; 2.0-12.2 mg/dl) with the laboratorial profile than in those without it (5.9; 0.90-33.8 mg/dl for men and 4.4; 0.8-30.0 mg/dl for women) (p < 0.0001). A significant increase in the prevalence of laboratory profile was observed in men (OR = 2.2 mg/dl; 95 percent CI: 1.2-3.9 mg/dl) and women (OR = 2.2 mg/dl; 95 percent CI: 1.4-3.5 mg/dl) with hyperuricemia. CONCLUSION: These results show the association between serum levels of uric acid and metabolic syndrome profile, which corroborates to similar results found in other populations worldwide.

INTRODUÇÃO: O ácido úrico sérico tem sido considerado um marcador ou componente das alterações clínicas e laboratoriais da síndrome metabólica. OBJETIVO: Avaliar a associação entre o ácido úrico sérico (AU) e o perfil laboratorial composto de glicemia de jejum > 100 mg/dl, triglicerídeos > 150 mg/dl e colesterol da lipoproteína de alta densidade (HDL-C) < 50 mg/dl nas mulheres e < 40 mg/dl nos homens. MÉTODO: Em estudo de corte transversal, amostras de sangue de 4.328 pacientes ambulatoriais não selecionados com idade variando de 20 a 102 anos foram examinadas. RESULTADOS: A mediana (variação interquartil) do AU foi mais elevada nos homens (6,7; 2,4-12,5 mg/dl) e mulheres (5,4;2-12,2 mg/dl) que apresentaram o perfil laboratorial do que nos que não o apresentaram (5,9; 0,9-33,8 mg/dl para os homens e 4,4; 0,8-30 mg/dl para as mulheres) (p < 0,0001). Observou-se aumento significativo na prevalência do perfil laboratorial nos homens (razão de chance [RC] = 2,2 mg/dl; intervalo de confiança [IC] 95 por cento: 1,2-3,9 mg/dl) e mulheres (RC = 2,2 mg/dl; IC 95 por cento: 1,4-3,5 mg/dl) com hiperuricemia. CONCLUSÃO: Esses resultados mostram a associação dos níveis séricos do acido úrico com o perfil laboratorial da síndrome metabólica nesse grupo não selecionado de indivíduos brasileiros atendidos ambulatorialmente, sendo este um achado semelhante ao observado em outras populações estudadas mundialmente.

Frequency of hyperuricemia in patients with ischemic heart disease

To determine the frequency of hyperuricemia, as a risk factor, in patients with ischemic heart disease in our setup. This prospective and observational study was carried out in the Departments of cardiology, medical unit III and pathology, Peoples Medical College and Hospital, Nawabshah from 15[th] January 2007 to 15[th] July 2007. Fifty patients, of any age and of either sex, diagnosed on ECG as ischemic heart disease [IHD] were selected and compared with serum uric acid [SUA] levels and age, sex, approximately body mass index [BMI] matched healthy controls. SUA was measured on 3[rd] day of admission by using enzyme uricase method on CLINIKON photometer 5010. Hyperuricemia was found in 27 out of 50 IHD patients and in 5 out of 50 controls; therefore a highly significant association was observed. Mean SUA level was 7.21 +/- 2.14 in patients with ischemic heart disease and 5.38 +/- 1.26 was found in healthy control subject. The difference between these two means was highly significant [P<0.0001]. Hyperuncemia significantly associates with IHD. It does not cause t IHD, neither is an independent risk factor but it only accelerates the process of atherosclerosis which can worsen the preexisting IHD

Estudio metabólico en pacientes con urolitiasis de alto riesgo de recurrencia / Metabolic study in patients with urinary lithiasis at high risk of recurrence

Introducción: La urolitiasis es considerada actualmente una enfermedad metabólica con tendencia ala recurrencia. El objetivo de este trabajo es evaluar la prevalencia de alteraciones metabólicas en pacientes de alto riesgo y su impacto según sexo y edad. Materiales y métodos: Es un estudio descriptivo de 36 pacientes (25 hombres y 11 mujeres), portadores de patología litiásica con alto riesgo de recurrencia. El estudio metabólico consistió en: calcemia, uricemia, fosfemia, PTH sérica, calciuria/24 hrs, uricosuria/24 hrs, fosfaturia/24 hrs, oxalaturia/24 hrs,citraturia/24 hrs y creatininuria/24 hrs. Los valores obtenidos fueron ajustados de acuerdo a la creatininuria y peso. Para el análisis estadístico se utilizó t-student (STATA 7.0). Se consideró significativo p<0,05.Resultados: En el 69 por ciento (25/36) se observó alguna alteración metabólica; el 36 por ciento (13/36) presentó 2 omás alteraciones metabólicas. Las alteraciones más frecuentes fueron la hipercalciuria (30,6 por ciento; 11/36), la hipocitraturia (30,6 por ciento; 11/36), la hiperuricemia (19,4 por ciento; 7/36) y la hiperoxalaturia (13, por ciento; 5/36).No se observó diferencias significativas de edad o sexo entre los grupos con y sin alteración metabólica. Conclusiones: La mayoría de los pacientes con patología litiásica recurrente o de alto riesgo presentan una o más alteraciones metabólicas, predominando la hipercalciuria y la hipocitraturia. En este estudio no hubo diferencias entre ambos sexos en la mayoría de las alteraciones metabólicas, ni tampoco en su distribución etaria. Estos resultados demuestran la necesidad de realizar estudios metabólicos en pacientes de alto riesgo, dado que existen herramientas terapéuticas que permiten un manejo médico de las alteraciones metabólicas y de esta forma reducir la recurrencia de litiasis.

Introduction: Urolithiasis is a metabolic disorder with a tendency to relapse. The aim of this study was to assess the prevalence of metabolic abnormalities in patients at high risk and the impact of sex and age. Materials and methods: Descriptive study of 36 patients (25 men and 11 women),with lithiasic pathology at high risk of recurrence. The metabolic study included the measurement of calcemia, uricemia, fosfemia, parathormone, calciuria/24hrs, uricosuria/24hrs, fosfaturia/24hrs, oxalaturia/24hrs, citraturia/ 24hrs and creatinine/24hrs. The values obtained were corrected according to weight and creatinine. The test used for statistical analysis was t-student (STATA 7.0). It was considered significant p <0.05.Results: In 69 percent (25/36) of the cases a metabolic abnormality was observed and in 36 percent (13/36) there was 2 or more alterations present. The metabolic disorders most frequently observed were hypercalciuria (30.6 percent; 11/36), hypocitraturia (30.6 percent; 11/36), hyperuricemia (19.4 percent; 7/36) and hyperoxaluria (13.9 percent; 5/36). There was no significant difference in age or sex between the groups with and without metabolic abnormality. Conclusions: Most patients with recurrent lithiasic pathology or at high-risk display one or more metabolic disorders, being hypercalciuria and hypocitraturia the most frecuently encountered. In this study, there was no difference between sexes in most of the metabolic disorders, nor in its age distribution. These results demonstrate the need for metabolic studies in high-risk patients, since there are tools that allow therapeutic medical management of metabolic disorders and thus reduce the recurrence of lithiasis.

Banding gástrico laparoscópico en pacientes obesos adolescentes / Gastric banding among obese adolescents

En EE.UU. existe un 4 por ciento de obesos adolescentes y un 80 por ciento de ellos llegará a ser obeso en la vida adulta. En Chile un 33 por ciento de los escolares púberes presentan obesidad y sobrepeso según datos del Ministerio de Salud. El objetivo de este trabajo es evaluar los resultados a corto y mediano plazo del banding gástrico por laparoscopía en el grupo de obesos adolescentes. Entre agosto del 2004 y enero 2005, se realizaron 21 banding gástricos por laparoscopía en obesos adolescentes. La edad promedio fue de 17 años (extremos 13 y 19), con un IMC de 38,6. La relación mujer/hombre fue de 2,5:1. No hubo mortalidad en la serie y se procedió al retiro en dos pacientes por deslizamiento a los seis meses postoperatorios. El tiempo operatorio fue de 60 minutos, con una estadía de 1,9 días. El porcentaje de pérdida de peso fue de 54,1 por ciento a los 12 meses y la resolución o mejoría de las comorbilidades alcanzó al 90 por ciento a los 6 meses. Los autores consideran al Banding Gástrico Laparoscópico como la técnica de elección el paciente obeso adolescente por tratarse de un método efectivo y seguro a mediano plazo. Es necesario un mayor seguimiento para evaluar sus resultados a largo plazo.

Background: Thirty percent of school age teenagers are obese in Chile. Aim: To assess the short and long term results of gastric banding among obese adolescents. Material and methods: Prospective evaluation of gastric banding procedures performed to 21 teenagers aged 13 to 19 years (15 females). Results: Mean body mass index of patients ranged from 31 to 51 kg/m2. Mean operative time and hospital stay were 60 minutes 1.9 days respectively. No patient died. Two bands had to be withdrawn after six months due to displacement. A 54% weight loss was obtained at 12 months of follow up and 90% of complications of obesity improved at 6 months. Conclusions: Gastric banding is a safe and effective surgical treatment for obesity in adolescents.