Skip to main content

Advertisement

SpringerLink
Log in

Is lower uric acid level better? A combined cross-sectional and longitudinal study in the elderly

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

The relationship between metabolic syndrome (MetS) and uric acid (UA) has been explored in many studies, but there is paucity of information on hypo-uricemia and MetS. The current study aimed to elucidate the relationship between the lower end of UA and MetS in elderly. Subjects aged ≥60 years who underwent routine health checkups were enrolled, and 10,579 were eligible for analysis. A cross-sectional study was first performed to determine the correlation between MetS and UA. The subjects were divided into two groups according to the lowest male MetS prevalence in each UA level (UA ≤5 and >5 mg/dl). A longitudinal study then excluded subjects with MetS at baseline to validate the UA level of those with the lowest incidence of MetS. In the prevalence of MetS in different UA levels, there was a J-shaped curve in males but a linear relationship in females. In males, waist circumference, systolic blood pressure, high-density lipoprotein, and triglyceride were correlated with UA in univariate analysis, but high-density lipoprotein became insignificant in multivariate analysis in UA >5 mg/dl (UA-high). Only fasting plasma glucose (FPG) was significantly related to UA ≤5 mg/dl (UA-low). The UA level of 4.5–5 mg/dl had the lowest risk of having MetS in odds ratio, log-rank test, and hazard ratio. A J-shaped phenomenon exists between UA and MetS in elderly men but not in elderly women and FPG seem to be the key factor in this. Lower UA does not provide benefits in elderly men. The new UA control strategy for the elderly warrants further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. G.M. Reaven, Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 37(12), 1595–1607 (1988)

    Article  CAS  PubMed  Google Scholar 

  2. N.M. Varda, A. Gregoric, Metabolic syndrome in the pediatric population: a short overview. Pediatric Rep 1(1), e1 (2009)

    Article  Google Scholar 

  3. N.J. Stone, S. Bilek, S. Rosenbaum, Recent National Cholesterol Education Program Adult Treatment Panel III update: adjustments and options. Am. J. Cardiol. 96(4A), 53E–59E (2005)

    Article  PubMed  Google Scholar 

  4. C.H. Hsu, J.Y. Wang, Y.L. Chen, C.C. Liu, Y.L. Chang, H.S. Chen, C. Pei, D. Pei, Relationships between alanine aminotransferase levels, abnormal liver echogenicity, and metabolic syndrome. J. Am. Board Fam. Med. JABFM 24(4), 407–414 (2011)

    Article  Google Scholar 

  5. J.Y. Wang, Y.L. Chen, C.H. Hsu, S.H. Tang, C.Z. Wu, D. Pei, Predictive value of serum uric acid levels for the diagnosis of metabolic syndrome in adolescents. J. Pediatr. 161(4), 753–756 (2012)

    Article  CAS  PubMed  Google Scholar 

  6. J.P. Goncalves, A. Oliveira, M. Severo, A.C. Santos, C. Lopes, Cross-sectional and longitudinal associations between serum uric acid and metabolic syndrome. Endocrine 41(3), 450–457 (2012). doi:10.1007/s12020-012-9629-8

    Article  CAS  PubMed  Google Scholar 

  7. R.D. Santos, Elevated uric acid, the metabolic syndrome and cardiovascular disease: cause, consequence, or just a not so innocent bystander? Endocrine 41(3), 350–352 (2012)

    Article  CAS  PubMed  Google Scholar 

  8. National Health Research Institutes. http://nahsit.nhri.org.tw/node/21. Accessed January 10

  9. K. Masuo, H. Kawaguchi, H. Mikami, T. Ogihara, M.L. Tuck, Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertension 42(4), 474–480 (2003)

    Article  CAS  PubMed  Google Scholar 

  10. A. Dehghan, M. van Hoek, E.J. Sijbrands, A. Hofman, J.C. Witteman, High serum uric acid as a novel risk factor for type 2 diabetes. Diabetes Care 31(2), 361–362 (2008)

    Article  CAS  PubMed  Google Scholar 

  11. C.K. Kramer, D. von Muhlen, S.K. Jassal, E. Barrett-Connor, Serum uric acid levels improve prediction of incident type 2 diabetes in individuals with impaired fasting glucose: the Rancho Bernardo Study. Diabetes Care 32(7), 1272–1273 (2009)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. S. Kodama, K. Saito, Y. Yachi, M. Asumi, A. Sugawara, K. Totsuka, A. Saito, H. Sone, Association between serum uric acid and development of type 2 diabetes. Diabetes Care 32(9), 1737–1742 (2009)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. E. Oda, R. Kawai, V. Sukumaran, K. Watanabe, Uric acid is positively associated with metabolic syndrome but negatively associated with diabetes in Japanese men. Intern. Med. 48(20), 1785–1791 (2009)

    Article  PubMed  Google Scholar 

  14. H. Nan, Y. Dong, W. Gao, J. Tuomilehto, Q. Qiao, Diabetes associated with a low serum uric acid level in a general Chinese population. Diabetes Res. Clin. Pract. 76(1), 68–74 (2007)

    Article  CAS  PubMed  Google Scholar 

  15. P. Bandaru, A. Shankar, Association between serum uric acid levels and diabetes mellitus. Int. J. Endocrinol. 2011, 604715 (2011)

    PubMed Central  PubMed  Google Scholar 

  16. S. Bo, P. Cavallo-Perin, L. Gentile, E. Repetti, G. Pagano, Hypouricemia and hyperuricemia in type 2 diabetes: two different phenotypes. Eur. J. Clin. Invest. 31(4), 318–321 (2001)

    Article  CAS  PubMed  Google Scholar 

  17. H.J. Yuan, X.G. Yang, X.Y. Shi, R. Tian, Z.G. Zhao, Association of serum uric acid with different levels of glucose and related factors. Chin. Med. J. 124(10), 1443–1448 (2011)

    CAS  PubMed  Google Scholar 

  18. K.G. Alberti, R.H. Eckel, S.M. Grundy, P.Z. Zimmet, J.I. Cleeman, K.A. Donato, J.C. Fruchart, W.P. James, C.M. Loria, S.C. Smith Jr, Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120(16), 1640–1645 (2009)

    Article  CAS  PubMed  Google Scholar 

  19. Department of Health, Executive Yuan, R.O.C. (Taiwan). Available at: http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=25&now_fod_list_no=5912&level_no=2&doc_no=22602. Accessed February 10, 2013

  20. C. Denzer, R. Muche, H. Mayer, E. Heinze, K.M. Debatin, M. Wabitsch, Serum uric acid levels in obese children and adolescents: linkage to testosterone levels and pre-metabolic syndrome. J. Pediatr. Endocrinol. Metab. JPEM 16(9), 1225–1232 (2003)

    Article  CAS  Google Scholar 

  21. J.D. Lin, W.K. Chiou, H.Y. Chang, F.H. Liu, H.F. Weng, Serum uric acid and leptin levels in metabolic syndrome: a quandary over the role of uric acid. Metab. Clin. Exp. 56(6), 751–756 (2007)

    Article  CAS  PubMed  Google Scholar 

  22. P.W. Liu, T.Y. Chang, J.D. Chen, Serum uric acid and metabolic syndrome in Taiwanese adults. Metab. Clin. Exp. 59(6), 802–807 (2010)

    Article  CAS  PubMed  Google Scholar 

  23. W.K. Chiou, D.H. Huang, M.H. Wang, Y.J. Lee, J.D. Lin, Significance and association of serum uric acid (UA) levels with components of metabolic syndrome (MS) in the elderly. Arch. Gerontol. Geriatr. 55(3), 724–728 (2012)

    Article  CAS  PubMed  Google Scholar 

  24. D.G. Cook, A.G. Shaper, D.S. Thelle, T.P. Whitehead, Serum uric acid, serum glucose and diabetes: relationships in a population study. Postgrad. Med. J. 62(733), 1001–1006 (1986)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. T.P. Whitehead, I. Jungner, D. Robinson, W. Kolar, A. Pearl, A. Hale, Serum urate, serum glucose and diabetes. Ann. Clin. Biochem. 29(Pt 2), 159–161 (1992)

    Article  PubMed  Google Scholar 

  26. P. Chou, K.C. Lin, H.Y. Lin, S.T. Tsai, Gender differences in the relationships of serum uric acid with fasting serum insulin and plasma glucose in patients without diabetes. J. Rheumatol. 28(3), 571–576 (2001)

    CAS  PubMed  Google Scholar 

  27. J.A. Robles-Cervantes, M.G. Ramos-Zavala, M. Gonzalez-Ortiz, E. Martinez-Abundis, C. Valencia-Sandoval, A. Torres-Chavez, C. Espinel-Bermudez, N.J. Santiago-Hernandez, S.O. Hernandez-Gonzalez, Relationship between serum concentration of uric acid and insulin secretion among adults with type 2 diabetes mellitus. Int. J. Endocrinol. 2011, 107904 (2011)

    CAS  PubMed Central  PubMed  Google Scholar 

  28. C. Meisinger, A. Doring, D. Stockl, B. Thorand, B. Kowall, W. Rathmann, Uric acid is more strongly associated with impaired glucose regulation in women than in men from the general population: the KORA F4-Study. PLoS ONE 7(5), e37180 (2012)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. B. Rocic, M. Vucic-Lovrencic, N. Poje, M. Poje, F. Bertuzzi, Uric acid may inhibit glucose-induced insulin secretion via binding to an essential arginine residue in rat pancreatic beta-cells. Bioorg. Med. Chem. Lett. 15(4), 1181–1184 (2005)

    Article  CAS  PubMed  Google Scholar 

  30. X. Sui, T.S. Church, R.A. Meriwether, F. Lobelo, S.N. Blair, Uric acid and the development of metabolic syndrome in women and men. Metab. Clin. Exp. 57(6), 845–852 (2008)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. E. Marinello, R. Leoncini, L. Terzuoli, D. Vannoni, B. Porcelli, G. Resconi, Effect of testosterone on purine nucleotide metabolism in rat liver. Hormone Metabol Res = Hormon- und Stoffwechselforschung = Hormones et metabolisme 36(9), 614–619 (2004)

    Article  CAS  Google Scholar 

  32. D.I. Feig, D.H. Kang, R.J. Johnson, Uric acid and cardiovascular risk. N. Engl. J. Med. 359(17), 1811–1821 (2008)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. D. Erdogan, H. Gullu, M. Caliskan, E. Yildirim, M. Bilgi, T. Ulus, N. Sezgin, H. Muderrisoglu, Relationship of serum uric acid to measures of endothelial function and atherosclerosis in healthy adults. Int. J. Clin. Pract. 59(11), 1276–1282 (2005)

    Article  CAS  PubMed  Google Scholar 

  34. J. Sundstrom, L. Sullivan, R.B. D’Agostino, D. Levy, W.B. Kannel, R.S. Vasan, Relations of serum uric acid to longitudinal blood pressure tracking and hypertension incidence. Hypertension 45(1), 28–33 (2005)

    Article  PubMed  Google Scholar 

  35. T.S. Perlstein, O. Gumieniak, P.N. Hopkins, L.J. Murphey, N.J. Brown, G.H. Williams, N.K. Hollenberg, N.D. Fisher, Uric acid and the state of the intrarenal renin-angiotensin system in humans. Kidney Int. 66(4), 1465–1470 (2004)

    Article  CAS  PubMed  Google Scholar 

  36. S. Watanabe, D.H. Kang, L. Feng, T. Nakagawa, J. Kanellis, H. Lan, M. Mazzali, R.J. Johnson, Uric acid, hominoid evolution, and the pathogenesis of salt-sensitivity. Hypertension 40(3), 355–360 (2002)

    Article  CAS  PubMed  Google Scholar 

  37. N. Ishizaka, Y. Ishizaka, E. Toda, R. Nagai, M. Yamakado, Association between serum uric acid, metabolic syndrome, and carotid atherosclerosis in Japanese individuals. Arterioscler. Thromb. Vasc. Biol. 25(5), 1038–1044 (2005)

    Article  CAS  PubMed  Google Scholar 

  38. R. Ross, Atherosclerosis—an inflammatory disease. N. Engl. J. Med. 340(2), 115–126 (1999)

    Article  CAS  PubMed  Google Scholar 

  39. J. Kanellis, D.H. Kang, Uric acid as a mediator of endothelial dysfunction, inflammation, and vascular disease. Semin. Nephrol. 25(1), 39–42 (2005)

    Article  CAS  PubMed  Google Scholar 

  40. A.C. Gagliardi, M.H. Miname, R.D. Santos, Uric acid: a marker of increased cardiovascular risk. Atherosclerosis 202(1), 11–17 (2009)

    Article  CAS  PubMed  Google Scholar 

  41. A. Onat, Metabolic syndrome: nature, therapeutic solutions and options. Expert Opin. Pharmacother. 12(12), 1887–1900 (2011)

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors sincerely thank the MJ Life Clinic in Taiwan for providing the anonymous data for the present study.

Conflict of interest

All the authors have no conflicts of interest in the present study.

Author information

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Chang-Hsun Hsieh

  2. Division of Endocrinology and Metabolism, Department of Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei, Taiwan

    Jiunn-Diann Lin & Chung-Ze Wu

  3. Department of Family Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan

    Chun-Hsien Hsu

  4. Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan

    Dee Pei

  5. Department of Life-Science, Fu-Jen Catholic University, New Taipei, Taiwan

    Yao-Jen Liang

  6. Department of Pathology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, No. 362, Chung-Cheng Road, Xindian, New Taipei, 23137, Taiwan

    Yen-Lin Chen

Authors
  1. Chang-Hsun Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiunn-Diann Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chung-Ze Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chun-Hsien Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dee Pei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yao-Jen Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yen-Lin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yen-Lin Chen.

Appendices

Appendix 1

See Fig. 4.

Fig. 4
figure 4

Description of the study design

Full size image

Appendix 2

See Table 2.

Table 2 The Kaplan–Meier estimates of metabolic syndrome during the follow-up period according to the uric acid level at baseline
Full size table

Appendix 3

See Fig. 5.

Fig. 5
figure 5

Univariate and multivariate analyses of uric acid and components of metabolic syndrome

Full size image

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hsieh, CH., Lin, JD., Wu, CZ. et al. Is lower uric acid level better? A combined cross-sectional and longitudinal study in the elderly. Endocrine 47, 806–815 (2014). https://doi.org/10.1007/s12020-014-0201-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-014-0201-6

Keywords

Search

Navigation