Relationship between hyperuricemia (HUC) and metabolic syndrome (MS) in institutionalized elderly men

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Abstract

This study investigated the relationship between hyperuricemia (HUC) and the components of the metabolic syndrome (MS) among elderly institutionalized men. In addition, this study explored the relationship between HUC and serum inflammatory markers. A total of 333 participants from Chang-Hua Veterans Care Home were enrolled. The MS was defined using a modified ATP III definition issued in 2004 by the Bureau of Health Promotion, Department of Health, ROC (Taiwan). The participants' mean age was 78.6±3.9 years, and their mean serum uric acid level was 6.9±1.7 mg/dl. The prevalence of HUC was 46.2% (n = 154). The prevalence of the MS was 38.4% (n = 128). HUC was correlated with components of the MS, including waist circumference (WC), triglyceride (TG), and high density lipoprotein cholesterol (HDL-C) but it was not related to blood pressure (BP) and fasting plasma glucose (FPG). Moreover, increased serum creatinine, albumin, prealbumin, and body fat were also associated with HUC. The plasma activator inhibitor-1 (PAI-1) levels were significantly elevated in the HUC group, but serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), serum intercellular cell adhesion molecule-1 (sICAM-1), serum levels of vascular cell adhesion molecule-1 (sVCAM-1), and P-selectin were not related to HUC. HUC in elderly men may represent poorer renal function, better nutritional status, and increased body fat.

Introduction

Recent studies showed that hyperuricemia (HUC) was closely related to metabolic syndrome (MS) and each of its components (Xuemei et al., 2008), and patients with HUC have poor cardiovascular outcomes (Kawamoto et al., 2006). Sautin and Johnson (2008) proposed the oxidant-antioxidant paradox of uric acid, which acts as a pro-oxidant primarily within the cell and as an anti-oxidant primarily in plasma. A high prevalence of HUC, which has been reported in elderly Taiwanese (46% for males and 26% for females), is significantly associated with the MS (Lee et al., 2005). A recent study also showed that an increased serum uric acid concentration was associated with a high prevalence of metabolic disorders such as obesity, dyslipidemia, and hypertension in the Chinese population (Cai et al., 2009). The results of recent studies suggested that HUC should be treated as a major metabolic abnormality and should be included in the definition of the MS (Lin et al., 2008). In contrast, Puig et al. (2008) claimed that HUC was simply a marker of the MS rather than a target to treat. Therefore, there continues to be uncertainty whether serum uric acid levels parallel the MS in the elderly, particularly males. The role of HUC in the pathogenesis of the MS remains unclear. In addition, the enrolled populations of previous studies were heterogeneous in race, age, and gender. In the present study, we attempted to investigate the association of HUC with the components of the MS and inflammatory markers in institutionalized elderly men in Taiwan.

Section snippets

Study participants

A total of 333 residents of the Chang-Hua Veterans Care Home, Taiwan, were enrolled from July 1 to August 31, 2002. The clinical demographic information, health profiles, and biochemical data were collected through formal administrative procedures and health examinations, including questionnaires, self-reported illnesses, and physical checkups. The Institutional Review Board of Taichung Veterans General Hospital reviewed and approved the study. All participants gave their written informed

Clinical features of the subjects with HUC and with normouricemia (NUC)

In total, 333 elderly men (mean age = 78.6±3.9 years; range, 70–91 years) were enrolled (Table 1). Serum uric acid levels were 6.9±1.7 mg/dl (range, 2.0–13.2 mg/dl). Overall, 154 (46.2%) subjects had HUC, and 128 (38.4%) had the MS. Subjects with HUC had greater WC (91.3±9.6 cm vs. 87.2±8.8 cm, p < 0.001), higher BMI (24.7±3.5 kg/m2 vs. 23.4±3.4 kg/m2, p = 0.002), higher TG (113.1±68.1 mg/dl vs. 89.5±49.7 mg/dl, p < 0.001), and lower HDLC (45.1±12.0 mg/dl vs. 48.9±12.8 mg/dl, p = 0.004) levels.

Discussion

A recent study showed that HUC might be a risk factor for cardiovascular events (Chien et al., 2005), and a positive correlation between uric acid level and carotid intima-thickness was seen in patients with hypertension (Tavil et al., 2008). Significant associations of HUC with visceral or central obesity, high BMI, high waist-hip ratio, and vascular endothelial dysfunction were also reported (Lee et al., 2005; Lin et al., 2007). Saggiani et al. (1996) reported that the major predictors of

Conclusions

The serum uric acid level in elderly institutionalized men was significantly correlated with impaired renal function, high body fat composition, high BMI, and high serum prealbumin level. Higher serum PAI-1 levels were found in subjects with HUC than in those without HUC, although the difference was not significant. There were no significant differences in CRP, IL-6, TNF-α, sICAM-1, sVCAM-1, and P-selectin levels between subjects with HUC and those without HUC. The association of HUC with the

Acknowledgements

The authors are grateful to the Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan, ROC for providing statistical analysis for this study.

Conflict of interest statement

The authors have no conflicts of interest to report.

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