U-shaped association of uric acid to overall-cause mortality and its impact on clinical management of hyperuricemia

Treatment response variations to a single large bolus of enteral cholecalciferol in vitamin D deficient critically Ill children: Metabolomic insights for precision nutrition

Vitamin D deficiency (VDD) is prevalent globally and in pediatric intensive care units, where it represents a modifiable risk factor that may impact patient recovery during hospitalization. Herein, we performed a retrospective analysis of serum samples from a phase-II randomized placebo-controlled trial involving a single large bolus of 10,000 IU/kg vitamin D3 ingested by critically ill children with VDD (25-OH-D < 50 nmol/L). Targeted and untargeted methods were used to comprehensively measure 6 vitamin D metabolites, 239 lipids, 68 polar metabolites, and 4 electrolytes using a multi-step data workflow for compound authentication. Complementary statistical methods classified circulating metabolites/lipids associated with vitamin D repletion following high-dose vitamin D3 intake (n = 20) versus placebo (n = 11) comprising an optional standard of care maintenance dose (< 1000 IU/day). There was a striking increase in median serum concentrations of 25-OH-D3 (4.7-fold), 3-epi-25-OH-D3 (24-fold) and their C3-epimer ratio (6.7-fold) in treated patients on day 3, whereas serum vitamin D3 peaked on day 1 (128-fold) unlike placebo. Treatment response differences were attributed to D3 bioavailability and C3-epimerase activity without evidence of hypercalcemia. For the first time, we report the detection of circulating 3-epi-D3 that was strongly correlated with vitamin D3 uptake (r = 0.898). Metabolomic studies revealed that vitamin D sufficiency (serum 25-OH-D >75 nmol/L) coincided with lower circulating levels of 3-methylhistidine, cystine, S-methylcysteine, uric acid, and two lysophosphatidylcholines 7 days after treatment. Rapid correction of VDD was associated with indicators of lower oxidative stress, inflammation, and muscle protein turn-over that may contribute clinical benefits in high-risk critically ill children.

Social determinants of health and mortality on hyperuricemia adults in the USA from 2007 to 2016: a national cohort study

BACKGROUND

Hyperuricemia is associated with higher all-cause and cardiovascular mortality. However, the role of social determinants of health (SDoH) in this context remains unclear. This study aims to examine the relationship between SDoH, hyperuricemia, all-cause and cardiovascular mortality, and explore the mediating role of SDoH in these relationships.

METHODS

This cohort study analyzed data from 23,919 US adults (aged ≥ 20) in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016, with linked mortality data through December 31, 2019. Two primary exposures were examined: hyperuricemia, defined as serum uric acid level > 420 µmol/L in males and > 360 µmol/L in females, and SDoH, which encompassed education level, marital status, income-to-poverty ratio (PIR), food security, health insurance, regular health-care access, housing instability, and employment. The primary outcomes were all-cause and cardiovascular mortality. Statistical methods included logistic regression, Cox proportional hazard model, and mediation analysis.

RESULTS

The study cohort had a mean (SD) age of 49.27 (17.63) years, with 48.28% (95%Cl, 47.69%-48.86%) being male, and 68.52% (95%Cl, 65.27%-71.60%) identified as non-Hispanic White. Having three or more unfavorable SDoH significantly mediated the link between hyperuricemia and both all-cause and cardiovascular mortality. SDoH ≥ 6, SDoH = 5, SDoH = 4, and SDoH = 3 mediated 20.30% (P = 0.004), 13.94% (P = 0.044), 23.59% (P = 0.018), and 13.88% (P = 0.008) of the association between hyperuricemia and all-cause mortality, respectively. SDoH ≥ 6, SDoH = 5, SDoH = 4, and SDoH = 3 mediated 15.35% (P = 0.006), 14.87% (P = 0.050), 20.68% (P = 0.026), and 9.45% (P = 0.012) of the association between hyperuricemia and cardiovascular mortality.

CONCLUSIONS

SDoH significantly mediated the relationship between hyperuricemia and both all-cause and cardiovascular mortality.

Trajectory of body shape in early and middle life and hyperuricemia: an observational study integrating mendelian randomization analysis

BACKGROUND AND AIM

Although it is recognized that obesity is linked to hyperuricemia, the research on how obesity at different stages of life affects hyperuricemia is still unclear.

METHODS AND RESULTS

Body shape trajectory of over the first 50 years of life in Henan Rural Cohort Study was accessed by using a group-based trajectory modeling approach. Multivariate logistic regression was utilized to estimate odd ratio (OR) for hyperuricemia. Causation was further assessed using mendelian randomization (MR). Five distinct trajectories were identified and a total of 22,655 participants were enrolled for final analysis. Compared to lean-stable participants, medium-moderate increase, heavy-stable, and lean-marked increase showed significantly higher OR and 95 % confidence interval (CI) for hyperuricemia, with 1.27 (1.07, 1.50), 1.81 (1.48, 2.21) and 1.84 (1.51, 2.25) for women, 1.25 (1.01, 1.54), 1.35 (1.02, 1.77) and 1.91 (1.50, 2.43) for men. This positive association was weakened in women with high healthy lifestyle score, but the weakening effect was not significant in men. Genetically predicted birth weight, childhood body mass index (BMI), and adult BMI were significantly associated with serum uric acid (SUA), with regression coefficient (β) and 95 % CI was -0.09 (-0.14, -0.04), 0.10 (0.04, 0.16), 0.20 (0.16, 0.24), respectively.

CONCLUSION

Body shape trajectory is closely associated with hyperuricemia, with MR analysis suggesting potential causal links. lifelong weight management and maintaining healthy lifestyles can reduce the adverse effects of weight gain on hyperuricemia.

Longitudinal Evaluation of Metabolic Benefits of Inactivated COVID-19 Vaccination in Diabetic Patients in Tianjin, China

BACKGROUND Diabetes significantly heightens risks of COVID-19 infection, and vaccine hesitancy remains high due to safety concerns. MATERIAL AND METHODS This study assessed the effects of inactivated COVID-19 vaccine in 548 diabetic patients from Tianjin, China, categorized by vaccination status: unvaccinated (n=94), primary immunization (n=117), and booster immunization (n=337). A total of 22 clinical values were assessed prior to vaccination, 3 months after vaccination, and 12 months after vaccination. Variables with a normal distribution were compared across groups using one-way ANOVA, while non-normally distributed variables were compared using the Kruskal-Wallis test and chi-square tests for categorical data. Linear mixed-effects models were used to evaluate the effects of time and vaccine type on these clinical values, with random intercepts to account for within-subject variability and interaction terms for detailed group comparisons over time. RESULTS Baseline results showed no major differences across groups, including fasting glucose, HbA1c, granulocytes, hemoglobin, platelets, renal function markers such as uric acid, creatinine, and eGFR. Booster vaccination significantly reduced FPG (Estimate=-0.123, p<0.001) and HbA1c (Estimate=-0.049, p<0.01), with primary vaccination also reducing FPG (Estimate=-0.118, p<0.001) and HbA1c (Estimate=-0.040, p<0.05). However, creatinine decreased and bilirubin levels rose in vaccinated groups but remained within the normal physiological range. Other indicators showed no significant changes. CONCLUSIONS In conclusion, COVID-19 inactivated vaccine can provide metabolic benefits for diabetic patients.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hyperuricemia: evidence from the CHARLS study

Background and aims

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is an innovative composite lipid measure. This study aims to examine the correlation between NHHR and hyperuricemia in the middle-aged and elderly demographic in China.

Methods

This investigation comprised 4,639 individuals who were devoid of hyperuricemia at baseline in 2011, utilizing data from the China Health and Retirement Longitudinal Study (CHARLS). We utilized multivariable logistic regression, restricted cubic spline (RCS) analysis, and subgroup analysis to investigate the relationship between NHHR and hyperuricemia.

Results

A total of 499 participants (10.76%) experienced hyperuricemia at the 4-year follow-up. The incidence of hyperuricemia was 176% higher for participants in the highest quartile of NHHR than for those in the lowest quartile (OR 2.76, 95% CI 2.10-3.62, p < 0.001). The risk of hyperuricemia was 64% higher in the highest quartile of NHHR than in the lowest quartile in a fully adjusted model (OR 1.64, 95% CI 1.16-2.31, p = 0.005). The risk of hyperuricemia and NHHR had a linearly positive connection, according to restricted cubic spline (RCS) analysis (P for non-linearity > 0.05). Subgroup analysis showed that among women, non-smokers, and those over 60, the relationship between NHHR and hyperuricemia was more significant.

Conclusion

NHHR and hyperuricemia have a substantial linear positive connection, indicating that NHHR might be used as a tool for assessing hyperuricemia risk and offering valuable information for both prevention and therapy.

Low Serum Uric Acid Levels are Associated with Severe Diabetic Foot Infection: A Cross-Sectional Study from China

Diabetic foot ulcers (DFUs) are among the most serious complications of diabetes which are associated with high disability and mortality rates. This study aims to investigate the associations between uric acid (UA) levels and diabetic foot ulcer (DFU) characteristics. In total, 1820 participants with DFUs were included in this study; 192 and 1628 participants were included in the hyperuricemia group (HUA, UA > 420 µmol/L) and the nonhyperuricemia group (NHUA, UA ≤420 µmol/L), respectively. The NHUA group was divided into a middle-UA subgroup (SMUA, 420 µmol/L ≥ UA ≥ 180 µmol/L; 304 individuals) and a low-UA subgroup (SLUA, UA <180 µmol/L; 1324 individuals). There were no significant differences in the rates of deep ulcers, severe infection or amputation between NHUA and HUA. In univariate analysis of subgroups, the differences in the rates of deep ulcers, severe infection and amputation were significant. After adjusting for confounders (sex, fasting glucose level, diabetes duration, eGFR, deep ulcers and severe infection) in multivariate analysis, the severe infection rate (OR = 4.0, 95%CI 1.6-10.0, P < 0.01) was still significantly greater in the SLUA group than in the SMUA group while the rate of deep ulcers (OR =2.4, 95%CI 1.0-6.1, P = 0.06) and amputation (OR =1.1, 95%CI 0.3-4.3, P = 0.91) showed non-statistical difference. UA levels below 180 µmol/L can be a risk factor for severe infection in DFUs.

Evaluation of the safety and probiotic properties of Limosilactobacillus fermentum BGI-AF16, a uric acid-lowering probiotic strain

Some beneficial microorganisms in the intestine have the potential to degrade uric acid, offering a novel strategy for the prevention of hyperuricemia. In this study, the safety and probiotic potentials of Limosilactobacillus fermentum BGI-AF16 were evaluated by whole genome sequence analysis and in vitro experiments. Based on the gene analysis of antibiotic resistance and virulence factors, L. fermentum BGI-AF16 has been shown to be safe. We identified probiotic-related genes by genome annotation tools and conducted in vitro experiments to evaluate the ability of L. fermentum BGI-AF16 to inhibit pathogenic bacteria, tolerate a simulated gastrointestinal environment, and degrade uric acid. The results from in vitro experiments showed that L. fermentum BGI-AF16 had inhibitory effects on four clinically relevant pathogens and was highly tolerant to the gastrointestinal environment. In addition, L. fermentum BGI-AF16 was able to rapidly degrade uric acid within the first hour, and the strain could degrade 56.36 ± 2.32 % of uric acid by the third hour. The genome of the strain contains genes encoding flavin adenine dinucleotide (FAD)-dependent urate hydroxylase (EC.1.14.13.113), an enzyme that directly metabolizes uric acid. And the strain has a complete uric acid metabolic pathway. These results suggest that L. fermentum BGI-AF16 is a probiotic candidate with significant potential for reducing uric acid level.

Oleanolic Acid Alleviates Hyperuricemia via Gut Microbiota Control the Integrity of Gut Barrier and the Expressions of Urate Transporter in Mice

Hyperuricemia (HUA) is a globally prevalent metabolic disorder characterized by an imbalance in uric acid (UA) production and excretion. In this study, we found that oleanolic acid (OA), a natural pentacyclic triterpene, effectively reduced HUA and associated kidney injury in C57BL/6J mice. A 12-week OA treatment significantly and dose-dependently reduced UA and creatinine levels in serum and urine while suppressing hepatic xanthine oxidase activity in HUA mice. Mechanistic analysis revealed that OA modulates the expression of urate transporters including ABCG2, GLUT9, and URAT1 in the kidney and small intestine. Furthermore, OA restored gut microbiota imbalances, increased short-chain fatty acid production, and enhanced the expressions of intestinal tight junction proteins in HUA mice, thereby improving gut barrier integrity in HUA mice. Consequently, fecal microbiota transplantation (FMT) was employed to illustrate the major mediating role of gut microbiota in OA's alleviation of HUA in mice. Recipient HUA mice transplanted with feces from OA-treated HUA mice exhibited significantly lower blood and urinary UA levels, reduced kidney inflammation, and improved gut microbiota balance compared to those receiving feces from untreated HUA mice (p < 0.05). Additionally, FMT normalized urate transporter expression and reinforced intestinal tight junctions in recipient mice. These findings underscore that OA mitigates HUA primarily by modulating gut microbiota, regulating urate transporter expression, and reinforcing gut barrier integrity, offering novel insights into its preventive potential for managing HUA and related complications.

Fe/Pt dual-atom catalyst-enabled wearable microfluidic patch for superior uric acid detection in sweat

Wearable sweat sensors offer a promising non-invasive approach for real-time physiological monitoring, with significant potential in personalized medicine. In this study, we present an innovative wearable patch designed for highly sensitive and accurate detection of uric acid (UA) in human sweat. The sensor integrates superior platinum-iron dual-atom catalysts (Pt/Fe DACs), developed based on iron single-atom catalysts (Fe SACs), to achieve selective and precise UA detection across a wide concentration range (6.25-1500 μM). To enhance the sensor's performance, a pH electrode based on polyaniline (PANI) is incorporated for reliable pH calibration. Density functional theory (DFT) calculations are used to explore the catalytic mechanism of UA detection and the synergistic interaction between Fe and Pt atoms in the catalyst, which improves sensor sensitivity. Additionally, we developed a microfluidic patch made of polydimethylsiloxane (PDMS) with enhanced hydrophilicity to facilitate efficient sweat collection. This work presents a valuable approach for advancing wearable sweat sensors for UA detection and offers a promising strategy for the application of wearable sensors in personalized health monitoring.

Excess Weight Loss at 6 Months Following Laparoscopic Sleeve Gastrectomy Correlates with the Remission of Hyperuricemia

BACKGROUND

Hyperuricemia is a metabolic disorder associated with obesity. Many studies have reported the effect of bariatric surgery on the decrease of serum uric acid level in patients with hyperuricemia. However, since the update of diagnostic criteria of hyperuricemia, the correlation between preoperative body mass index, postoperative weight changes, and the remission of hyperuricemia in patients with obesity after sleeve gastrectomy requires consensus.

METHODS

One hundred and ninety-three patients with obesity and hyperuricemia who underwent laparoscopic sleeve gastrectomy were enrolled. All patients were followed up for 6 months postoperatively. Subgroup analysis was performed using the tertiles of preoperative body mass index, total weight loss, and excess weight loss to investigate the correlation with the remission of hyperuricemia after sleeve gastrectomy.

RESULTS

A total of 193 patients were included in this study. Among them, 123 patients were female and 70 were male. And the mean age was 30.2 ± 7.8 years, preoperative body weight was 116.1 ± 23.3 kg, and the preoperative BMI was 40.5 ± 6.7 kg/m2. 59.1% (114/193) patients achieved remission of hyperuricemia 6 months after sleeve gastrectomy. The TWL% and EWL% were 25.6% ± 5.4% and 75.9% ± 28.2%, respectively. Female patients had a significantly higher remission rate than that of male patients (p < 0.05). Correlations were found between EWL%/preoperative BMI with the remission of hyperuricemia (p < 0.05).

CONCLUSION

Sleeve gastrectomy had a positive effect on the remission of hyperuricemia in patients with obesity. EWL% may play a significant role in the remission of hyperuricemia.

Association Between TyG-BMI Index and Hyperuricemia in Adult Women

PURPOSE

This study aimed to explore the relationship between hyperuricemia (HUA), the triglyceride-glucose index (TyG) and its derivatives in adult women.

METHODS

A cross-sectional analysis was conducted on 1105 female patients from Shanghai Tenth People's Hospital. Participants were divided into HUA (n = 331) and non-HUA (n = 774) groups. Clinical and laboratory data were collected, and indices such as body mass index (BMI), TyG and TyG-BMI were calculated. Statistical analyses included univariate and multivariate logistic regression and receiver operating characteristic (ROC) curve analysis.

RESULTS

The HUA group showed higher BMI, blood pressure and metabolic parameters. TyG, TyG-BMI and BMI were positively correlated with uric acid levels. ROC analysis revealed that TyG-BMI (AUC = 0.877) had better predictive power for HUA than TyG (AUC = 0.829) or BMI (AUC = 0.867). Multivariate analysis showed TyG-BMI and BMI as independent predictors, with women in the highest quartiles having a 3.111-fold and 2.779-fold higher risk for HUA, respectively.

CONCLUSION

TyG-BMI is the most effective predictor of HUA in women, surpassing TyG and BMI alone. It offers a practical tool for early identification and intervention in women at risk of HUA.

Effects of WN1703 on Cardiovascular Function in Chronic Hyperuricemia Rats and Myocardial Injury Mechanism Exploration in H9C2 Cells

Hyperuricemia, a prevalent condition, is typically preceded by disturbances in purine metabolism and is frequently associated with hyperlipidemia and other dysfunctions of metabolism. WN1703 demonstrated an inhibitory activity against xanthine oxidoreductase (XOR) that was comparable to febuxostat in our prior investigation. In this study, we assessed the cardiovascular safety of WN1703 in a chronic hyperuricemia rat model induced by potassium oxonate in combination with hypoxanthine. We investigated the changes in cardiovascular biomarkers in chronic hyperuricemia rats treated with febuxostat and WN1703, including creatine kinase (CK), CK-MB, B type natriuretic peptide (BNP), Corin protein (CRN), Neprilysin (NEP), myeloperoxidase (MPO), 8-hydroxy-2-deoxyguanosine (8-OHdG), tumor necrosis factor (TNF-α), interleukin-1β (IL-1β), and interleukin-8 (IL-8). Additionally, we validated the potential mechanism of cardiac injury induced by WN1703 in H9C2 cells, guided by cardiotoxicity predictions from the cardioToxCSM database and network pharmacology. We observed that excessively rapid urate-lowering, oxidative stress, and inflammation could disrupt myocardial functional homeostasis and increase the risk of cardiovascular injury in hyperuricemia rats, and WN1703 treatment effectively reduced the levels oxidative stress marker 8-OHdG and inflammatory factor TNF-α. Despite the absence of organic damage to the heart with prolonged treatment of febuxostat and WN1703, potential hazard of cardiovascular injury could be associated with the modulation of the TGFβ and RHO/ROCK signaling pathways by febuxostat and WN1703. This could offer new insights into the mechanisms underlying the adverse effects caused by XOR inhibitors.

Hypouricemic effect of sodium glucose transporter-2 inhibitors: a network meta-analysis and meta-regression of randomized clinical trials

BACKGROUND

Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are known for their cardiovascular benefits, but their impact on serum uric acid levels is not well understood. This study evaluates the hypouricemic effects of SGLT2is and their potential cardiovascular implications.

METHODS

A network meta-analysis was performed, including 56 studies (16,788 participants) contributing data to the meta-analysis. The effects of SGLT2is on serum uric acid levels were analyzed with weighted mean difference (WMD) as the effect estimate. Bootstrapped meta-analysis, trial sequential analysis, and meta-regression were utilized to validate the findings and assess the influence of covariates. The certainty of the evidence was evaluated.

RESULTS

The analysis revealed that SGLT2is significantly reduced serum uric acid levels (WMD: -40.01 μmol/L). Specific reductions were noted for ertugliflozin (-42.17 μmol/L), dapagliflozin (-40.28 μmol/L), empagliflozin (-46.75 μmol/L), canagliflozin (-35.55 μmol/L), and ipragliflozin (-10.48 μmol/L). Both low and high doses were effective, with empagliflozin showing the highest efficacy. No significant associations were found with covariates. The evidence was of moderate certainty.

CONCLUSION

SGLT2is significantly lower serum uric acid levels, with empagliflozin being the most effective. These findings suggest a potential role in reducing cardiovascular risk. Further research is needed to explore their effects on hyperuricemic patients, and monitoring serum uric acid levels is recommended.

Association between hyperuricemia and all-cause mortality in people taken Statins: a retrospective cohort study

Background

Statins are one of the most widely prescribed medicines in clinical practice. Their benefits have extended beyond cardiovascular applications to reduce serum uric acid levels. This study aims to investigate the relationship of hyperuricemia with the risk of all-cause mortality among individuals taking statins.

Method

A retrospective cohort study was performed using data from the National Health and Nutrition Examination Survey (NHANES) database between 2005 and 2018. The weighted Cox proportional hazards models were used to investigate the relationship between hyperuricemia and all cause-mortality.

Results

A total of 1,958 participants were enrolled for analysis. Of them 1,429 participants were with normal uric acid levels and 529 people were with hyperuricemia. After 12 years of follow-up, there were 267 participants who died from all-cause mortality in the non-hyperuricemia group and 136 died in the hyperuricemia group. Additionally, 32.49% of participants took more than five kinds of medicines in the non-hyperuricemia group compared to 42.05% participants in the hyperuricemia group. Even after adjusting for confounding factors, we found that the serum uric acid (SUA) level was significantly correlated with all-cause mortality among statin users (HR = 1.13, 95% CI:1.02-1.24, p = 0.0161). Additionally, hyperuricemia resulted in significant increases in all-cause mortality relative to non-hyperuricemia participants in three models (HR = 1.51, 95% CI:1.16-1.96, P = 0.0023).

Conclusion

Although statins have been shown to reduce uric acid levels, hyperuricemia is still significantly associated with the all-cause mortality in people taking statins. Those taking statins and having hyperuricemia should pay special attention to their SUA level.

Association between Hp infection and serum uric acid to high-density lipoprotein cholesterol ratio in adults

Background

Helicobacter pylori (Hp) infection is one of the major global health problems resulting in multiple system disorders. The serum uric acid to high density lipoprotein cholesterol ratio (UHR) is a novel index of inflammation and metabolism, but its association with the development of Hp infection is still unclear.

Materials and methods

This is a cross-sectional study involving 2,666 participants, using data from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States. The relationship between UHR and Hp infection was evaluated by multivariate logistic regression and sensitivity analysis to enhance the stability of the results.

Results

Among all individuals, 1,165 were Hp positive (43.7%) and 1,501 were Hp negative (56.3%). After adjustment, there was a positive correlation between UHR and Hp infection (OR = 1.15; 95% CI 1.02-1.30; P = 0.020). This association is relatively stable in the subgroup analysis (P > 0.05).

Conclusion

There is a positive correlation between the UHR and the development of Hp infection in our study. This non-invasive indicator can improve the ability to monitor Hp infection and may find alternative therapeutic intervention targets.

Interplay between BMI, neutrophil, triglyceride and uric acid: a case-control study and bidirectional multivariate mendelian randomization analysis

BACKGROUND

This study aims to explore the interplay between body mass index (BMI), neutrophils, triglyceride levels, and uric acid (UA). Understanding the causal correlation between UA and health indicators, specifically its association with the body's inflammatory conditions, is crucial for preventing and managing various diseases.

METHODS

A retrospective analysis was conducted on 4,286 cases utilizing the Spearman correlation method. BMI, neutrophil count, and triglyceride levels were determined as key exposure factors. To further investigate the causal correlation, a two-sample Mendelian randomization(MR) design was utilized, leveraging data from genome-wide association study (GWAS). Within this framework, and multivariable Mendelian randomization(MVMR) was applied to explore the linkage between multiple genetic variants and complex traits.

RESULTS

The study primarily focused on UA, employing genetic variation as a natural tool to assess the causal impact of various factors on UA. Spearman correlation analysis revealed significant association between UA and BMI (ρ = 0.230,p<0.01), neutrophils (ρ = 0.164,p<0.01), and triglyceride levels (ρ = 0.154,p<0.01). Additionally, two-sample MR analysis affirmed a reciprocal causal association between neutrophils and UA (OR = 1.035,95%CI:1.009-1.061,p = 0.008), as well as positive causal connection between UA and both BMI (OR = 1.083,95%CI:1.042-1.126,p<0.001) and triglyceride levels (OR = 1.090,95%CI:1.037-1.146,p<0.001). Neutrophils also demonstrated a positive causal linkage with BMI (OR = 1.034,95%CI:1.009-1.078,p = 0.012) and triglyceride levels (OR = 1.077,95%CI:1.033-1.122,p<0.001), and BMI exhibited a similar causal association with triglyceride levels (OR = 1.300,95%CI:1.212-1.385,p<0.001). These findings shed light on the causal networks connecting UA, BMI, neutrophils, and triglyceride levels. By integrating Spearman correlation analysis with various MR study designs, this study provided a robust framework for identifying key factors influencing hyperuricemia and related health issues, thereby enhancing our understanding of the interplay between inflammatory markers and these health indicators.

CONCLUSIONS

Our study presents strong evidence of the complex interconnection between BMI, neutrophils, triglyceride, and UA, revealing complex causal links and highlighting potential inflammatory states as key mediators. The findings may contribute to a better understanding of these factors and potentially lead to improved clinical outcomes and patients' health.

Correlation between Chinese visceral adiposity index and serum uric acid levels in type 2 diabetes mellitus patients

Purpose

The Chinese Visceral Adiposity Index (CVAI), a measure of visceral adiposity dysfunction, is used to assess visceral fat (VFA) malfunction. This research was performed to evaluate the relationship between CVAI and serum uric acid levels in type 2 diabetes mellitus (T2DM) patients.

Methods

A total of 2268 patients with T2DM were enrolled in this study. We collected the general clinical information of patients, measured the basic anthropometric indicators, tested glycolipid metabolism and biochemical indicators, and measured the visceral and subcutaneous fat area with bioelectrical impedance technology. According to the quartiles of the CVAI, the T2DM patients were classified into four groups: group A (CVAI ≤ 94.43), group B (94.43

Results

Among quartiles of CVAI, as CVAI increased, the proportion of patients with HUA gradually increased. The correlation analysis showed that the majority of basal measures, glycolipid metabolism and biochemical indicators were positively correlated with CVAI. By comparison, the level of CVAI in the HUA group was significantly higher than non-HUA group. Meanwhile, through using the ROC curve, our study observed the more predictive value of CVAI than other obesity indicators for T2DM with HUA.

Conclusion

CVAI is a simple but effective indicator, which is significantly correlated with HUA in T2DM and can reflect the incidence of HUA in T2DM patients. As CVAI increased, the risk of HUA in T2DM patients increased. Therefore, we should pay more attention to the application of CVAI in T2DM.

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Key Words

• Chinese visceral adiposity index
• hyperuricemia
• obesity
• type 2 diabetes mellitus
• uric acid

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MESH Headings

• Humans
• Diabetes Mellitus, Type 2/blood
• Male
• Female
• Middle Aged
• Uric Acid/blood
• Intra-Abdominal Fat
• Adiposity
• Aged
• China/epidemiology
• Hyperuricemia/blood
• Adult
• Biomarkers/blood
• Obesity, Abdominal/blood
• East Asian People

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Affiliation(s)

Swailla Amina Araújo Intchasso Adotey
Qian Zhang
Mengxue Chen
Yang Jiao
Yin Zhang
Claudette Butoyi
Dong Wang
Ling Yang
Guoyue Yuan Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Institute of Endocrine and Metabolic Diseases, Jiangsu University, Zhenjiang, China
Jue Jia Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Institute of Endocrine and Metabolic Diseases, Jiangsu University, Zhenjiang, China

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Collaborators Collapse

Uric acid to albumin ratio is a novel predictive marker for all-cause and cardiovascular death in diabetic patients: a prospective cohort study

Background

Diabetes is one of the leading causes of death with an increasing prevalence worldwide. Diabetes-related premature mortality is largely preventable and reversible if identified and managed early. Accordingly, we intend to investigate the predictive value of uric acid to albumin ratio (UAR) for all-cause and cardiovascular death in diabetic patients.

Methods

Univariate and multivariate Cox regression analyses were performed to identify risk factors for all-cause death of diabetic patients. The receiver operating characteristic (ROC) curves and nomogram model were used to evaluate the predictive ability of variables. Kaplan-Meier survival analysis was used to display the progression risks of diabetic patients.

Results

A total of 804 diabetic patients were enrolled in the study. During the 5-year follow-up, all-cause death was found in 80 participants (9.95%) and cardiovascular death was found in 24 participants (2.99%). Age, UAR, and hsCRP were independent risk factors for all-cause death in diabetic patients after adjusting for potential confounding factors. Age and UAR had good predictive value for 1-, 3-, and 5-year all-cause death in diabetic patients, and the combination of UAR and age had the highest predictive value. An easy and intuitive prognostic nomogram model with good predictive accuracy was constructed based on age and UAR. Patients in higher quantiles of age and UAR had more rapid progression to all-cause death and higher mortality risk than patients in the lower quantiles. UAR also had good predictive value for cardiovascular death in diabetic patients.

Conclusions

UAR may be a simple, cost-effective, and reliable predictive marker for all-cause and cardiovascular death in U.S. diabetic patients. The clinical utility of UAR and nomogram based on age and UAR can help physicians identify individuals at higher risk and therefore promote prevention strategies.

Inverse relationship of oxidative balance score with hyperuricemia among Chinese adults: a population-based cross-sectional study

BACKGROUND

The oxidative balance score (OBS) is a composite metric highlights pro-oxidants and antioxidants balance, representing the overall burden of oxidative stress. This study aims to examine the association between OBS and hyperuricemia in a Chinese population.

METHODS

This study was based on population-based cross-sectional survey data of Fujian province from August 2020 to April 2021. OBS was determined based on 10 food and lifestyle OBS components. The association between OBS and hyperuricemia was investigated using logistic regression analysis. Subgroup analyses identified sensitive populations. Restricted cubic spline (RCS) was performed to examine the potential dose-response relationship.

RESULTS

A total of 9464 participants were included in the final analysis. An inverse association between OBS and hyperuricemia was observed and remained after adjusting for potential confounders. Each additional unit of OBS was associated with a 4% and 7% reduction in the risk of hyperuricemia in men [OR: 0.96(0.94,0.99)] and women [OR: 0.93(0.90,0.96)], respectively. Participants in the highest quartile had a 22% and 37% lower risk of hypertension compared with the lowest quartile of OBS in men [0.78(0.62,0.97)] and women [OR: 0.63(0.49,0.79)], respectively. There were significant interactions between OBS and gender, hypertension, and dyslipidemia on hyperuricemia (Pinteraction < 0.05), except for age, education, and diabetes (Pinteraction > 0.05). A linear dose-response relationship between OBS and the risk of hyperuricemia (Pnonlinear = 0.7854) was observed.

CONCLUSIONS

An inverse association as well as dose-response relationship between OBS and hyperuricemia were observed. Increasing antioxidant levels through lifestyle modification may be an effective way to prevent hyperuricemia, especially in women. Large prospective cohort studies and randomized controlled trials are required to verify the effect of OBS on hyperuricemia and elucidate its causal mechanism.

Association between serum uric acid, hyperuricemia and low muscle mass in middle-aged and elderly adults: A national health and nutrition examination study

BACKGROUNDS

Recent research suggests that uric acid, as a metabolite with antioxidant properties, may affect muscle function and health. However, the association between serum uric acid (SUA) and low muscle mass remains relatively obscure. This study focuses on the association between SUA and low muscle mass in a middle-aged and elderly population in the United States.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey (NHANES), a total of 12,106 patients aged ≥45 years, possessing complete analytical data, were incorporated. Low muscle mass in our study is defined as indices below 0.789 for males and 0.512 for females, according to the FNIH Biomarkers Consortium. Gender stratified analyses were conducted employing a multivariate weighted logistic regression model. When examining serum uric acid (SUA) levels, the SUA dataset was stratified into deciles, and odds ratios (ORs) were calculated across distinct subgroups of males and females. A restricted cubic spline (RCS) method was employed to investigate the potential nonlinear association between SUA levels and low muscle mass. A series of subgroup analyses stratified by demographic variables and clinical experience were conducted.

RESULTS

A total of 2,185 participants (18.05%) were identified with low muscle mass, comprising 1,121 males and 1,064 females. Females with low muscle mass had higher SUA levels and an increased incidence of hyperuricemia compared to those without low muscle mass. In females, a fully adjusted multivariable weighted regression model revealed a positive association between hyperuricemia and low muscle mass (OR, 1.43; 95% CI, 1.06 to 1.92; P = 0.021). No significant association was observed in males. Additionally, RCS curves indicated a J-shaped relationship between increasing SUA levels and the risk of low muscle mass in females, and an inverse J-shaped relationship in males.

CONCLUSIONS

This study reveals a significant positive correlation between hyperuricemia and the risk of low muscle mass in middle-aged and older women in the United States, whereas the relationship between SUA levels and low muscle mass did not attain statistical significance. In the male cohort, neither SUA levels nor hyperuricemia demonstrated a significant association with low muscle mass.

Baseline Fasting Glucose Level, Age, Sex, and Body Mass Index and the Development of Diabetes in US Adults

Importance

Understanding the interplay between diabetes risk factors and diabetes development is important to develop individual, practice, and population-level prevention strategies.

Objective

To evaluate the progression from normal and impaired fasting glucose levels to diabetes among adults.

Design, Setting, and Participants

This retrospective community-based cohort study used data from the Rochester Epidemiology Project, in Olmsted County, Minnesota, on 44 992 individuals with at least 2 fasting plasma glucose (FPG) measurements from January 1, 2005, to December 31, 2017. People who met criteria for diabetes on or before their first FPG measurement were excluded. Data were electronically retrieved in December 2019 with analyses finalized in November 2024.

Exposures

The exposure was baseline FPG level, with covariates including the following measures that are consistently recorded in the electronic health record: body mass index (BMI), age, and sex.

Main Outcomes and Measures

The cumulative probability of freedom from diabetes was estimated and presented graphically using a Kaplan-Meier curve. Multivariable Cox proportional hazards regression modeling was used to estimate the partial hazard ratios (HRs) for variables of interest. Diabetes was defined as an FPG level greater than 125 mg/dL.

Results

A total of 44 992 individuals (mean [SD] age at baseline, 43.7 [11.8] years; 26 025 women [57.8%]) were included. The baseline mean (SD) BMI was 28.9 (6.6). Over a median follow-up of 6.8 years (IQR, 3.6-9.7 years), 3879 individuals (8.6%) developed diabetes. The Kaplan-Meier 10-year cumulative risk of incident diabetes was 12.8% (95% CI, 12.4%-13.2%). All initial FPG levels outside a range of 80 to 94 mg/dL were associated with increased risk for diabetes (ie, FPG <70 mg/dL: HR, 3.49 [95% CI, 2.19-5.57]; FPG 120-125 mg/dL: HR, 12.47 [10.84-14.34]). Other independent risk factors were male sex (HR, 1.31 [95% CI, 1.22-1.40]), older age (≥60 years: HR, 1.97 [95% CI, 1.71-2.28]), and any abnormal category of BMI, including underweight (BMI <18.5: HR, 2.42 [95% CI, 1.77-3.29]; BMI ≥40: HR, 4.03 [95% CI, 3.56-4.56]). There was a significant additive association of variables, particularly FPG level and BMI. For instance, a woman aged 55 to 59 years with a BMI of 18.5 to 24.9 and an FPG level of 95 to 99 mg/dL had an estimated 10-year diabetes risk of 7.0%. However, an almost doubling of risk to 13.0% was observed if the BMI was 30.0 to 34.9, and risk more than doubled again to 28.0% if FPG level also increased to 105 to 109 mg/dL. A nomogram was generated to facilitate individual classification into one of four 10-year risk categories.

Conclusions and Relevance

This retrospective cohort study of 44 992 individuals suggests that FPG level, age, BMI, and male sex were all associated with development of diabetes, with significant interaction between these variables. These data contribute to understanding the clinical course of diabetes and highlight the substantial individual variation in diabetes risk according to commonly measured clinical variables. The findings facilitate lifestyle and pharmacologic interventions to treat those at highest risk of diabetes to reduce future morbidity and mortality. Further work is needed to validate this risk categorization tool for different populations.

Associations of dietary choline intake and kidney function with hyperuricemia in Chinese children and adolescents: a cross-sectional study

Background

Limited studies have suggested an effect of dietary choline intake on uric acid levels. We aim to investigate the associations between choline intake and hyperuricemia (HUA), as well as the mediating role of kidney function in this relationship, among the Chinese population aged 6-17 years.

Methods

Participants were divided into quartiles according to residual energy-adjusted dietary choline intake in our cross-sectional study. Dietary choline intake was assessed using the 24-h dietary recalls method over three consecutive days, including two weekdays and one weekend day. The primary outcome was the HUA prevalence. Based on recommendation in Clinical Paediatric Nephrology (3rd ed), HUA is defined based on fasting serum uric acid levels, with cutoffs varying by age and sex. The associations between choline intake and HUA were analysed using weighted logistic regression models, restricted cubic spline models, and linear regression models. The mediated proportions of estimated glomerular filtration rate (eGFR) in the associations were estimated with mediation effect models. The data for this study were collected from the China National Nutrition and Health Surveillance of Children and Lactating Mothers (2016-2017) conducted between October 2016 and December 2018. Eligible participants were identified through a database search conducted from October to December 2023.

Findings

Among the 10749 participants, 3398 (31.6%) individuals were found to have HUA. A negative dose-dependent relationship was found between dietary choline intake and HUA. Compared to participants in the lowest intake quartile of total choline, phosphatidylcholine, and betaine, those in the 4th quartile had lower odds of HUA, with odds ratio (OR) of 0.75 (95% confidence interval [95% CI], 0.63-0.90), 0.75 (95% CI, 0.64-0.89), and 0.75 (95% CI, 0.59-0.94), respectively. The eGFR mediated 10.60%-14.58% of the associations. Participants in the 4th quartile of lipid-soluble dietary choline exhibited 24.00% reduced odds of HUA compared to those in the lowest intake quartile, with an OR of 0.76 (95% CI, 0.64-0.90).

Interpretation

Moderate to high intake of dietary choline (181.20-357.92 mg/d), particularly phosphatidylcholine (120.22-207.58 mg/d), and betaine (189.24-282.37 mg/d), may reduce the odds of HUA by improving glomerular filtration function. Further interventional studies are needed to establish causal relationships.

Funding

This work was supported by the National Natural Science Foundation of China (82003443, 42375180), the Natural Science Foundation of Guangdong Province of China (2024A1515012088), and the Construction of High-level University of Guangdong (G624330422).

Association of LDL-C/HDL-C Ratio With Hyperuricemia: A National Cohort Study

Hyperuricemia (HUA) is a metabolic abnormality syndrome caused by disorders of purine metabolism. This study aimed to investigate the predictive value of the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (LHR) for the risk of developing HUA. We extracted data from the China Health and Retirement Longitudinal Study (CHARLS) database from 2011 to 2016. Multivariable logistic regression, restricted cubic splines (RCSs) analysis, and linear correlation analysis were conducted to evaluate the association between LHR and risk of developing HUA. Subgroup analyses and interaction tests were also performed. A higher LHR was associated with an increased incidence of HUA (7.8% vs. 9.9% vs. 13.9, p < 0.001). The LHR was also higher in the HUA group compared to the non-HUA group (2.64 ± 1.07 vs. 2.40 ± 0.91, p < 0.001). When assessed as a continuous variable, LHR was independently associated with the risk of HUA (OR = 1.27, 95% CI = 1.16-1.39, p < 0.001). The risk of developing HUA was significantly higher among individuals with the highest LHR subgroup than those with the lowest LHR subgroup (OR = 1.81, 95% CI = 1.47-2.23, p < 0.001). RCS analysis revealed a significant nonlinear association between an increased LHR and a higher risk of developing HUA. The predictive abilities of LHR for HUA were 0.577. The composite variable comprising LHR and other traditional risk factors could significantly enhance the ability to predict HUA (C statistic = 0.677). In conclusion, a higher LHR was associated with an increased risk of developing HUA. Further studies on LHR could be beneficial for preventing and treating HUA.

Nonlinear association between the serum uric acid-to-creatinine ratio and all cause mortality in patients with hypertension: a ten-year cohort study using the NHANES database

The serum uric acid-to-creatinine ratio (UCR) may be a simple method for assessing xanthine oxidase overactivation, which may contribute to an increase in serum uric acid production and oxidative stress. In this study, we investigated the nonlinear association between the UCR and long-term mortality in patients with hypertension. Data were acquired from the National Health and Nutrition Examination Survey database, and a total of 11,346 patients with hypertension were included. We explored the nonlinear link between the UCR and all-cause mortality via spline smoothing, threshold saturation, and log-likelihood ratio tests. The results were validated through a competing risk model. A nonlinear pattern emerged between the UCR and all-cause mortality in hypertensive patients, with an inflection point at 4.3. Below this point, an increased UCR was associated with a decreased mortality risk (OR = 0.80, 95% CI: 0.68-0.94, P = 0.008), whereas above this point, the risk increased (OR = 1.21, 95% CI: 1.07-1.36, P = 0.004). The competing risk model yielded similar findings for cardiovascular and chronic kidney disease-related deaths. In patients with hypertension, the UCR nonlinearly predicted all-cause mortality, with a notable inflection at 4.3. These findings suggest that the UCR is a valuable prognostic indicator for assessing long-term outcomes in patients with hypertension.

Prevalence and clinical significance of hypouricemia in the emergency department

Hypouricemia prevalence has been reported in different clinical settings, but its prevalence and characteristics in the emergency department (ED) are limitedly studied. This study aimed to assess hypouricemia prevalence and clinical significance in the ED of a Turkish tertiary-care hospital. It was a retrospective, single-center observational study. Patients aged 18 years and older who presented to the ED between June 1, 2022 and June 1, 2023 were included. Data including age, gender, comorbid disease, final diagnosis, serum electrolytes, albumin, and serum uric acid (SUA) levels were obtained. SUA <2 mg/dL was considered as hypouricemia. The study included 35,923 patients, 362 of whom had SUA <2 mg/dL. The prevalence of hypouricemia was 1.008% and was higher in women (1.4% vs 0.4%, P < .001). Hypouricemic patients were younger than non-hypouricemic ones (34.5 [26-57] vs 50 [31-68], P < .001). Hypouricemic patients had a higher 6-month mortality rate than non-hypouricemic patients (5.2% vs 2.8%, P = .006). Among hypouricemic patients, men had a higher mortality rate than women (12.9% vs 3.4%, P = .004). A total of 33.7% of hypouricemic patients were pregnant, and the most common final diagnosis in the ED was abortus imminens, with 17.7%. The prevalence of hypouricemia in ED patients differs between genders. Hypouricemia increases 6-month mortality, more so in men. Obstetric pathologies are the most common final diagnosis of ED in hypouricemic patients. SUA can be monitored as a useful biomarker to ensure a healthy pregnancy and has a warning role in predicting mortality risk. Further studies are needed on hypouricemia.

The relationship between serum uric acid levels and liver stiffness in patients with type II diabetes mellitus and fatty liver disease

OBJECTIVE

High serum uric acid levels are associated with metabolic syndrome and diabetes mellitus. Several observational studies have shown the association between metabolic dysfunction-associated fatty liver disease and high serum uric acid. However, this association is controversial due to reverse causality. We aimed to investigate the relationship between the serum uric acid level and "aspartate aminotransferase-platelet ratio index score," which noninvasively shows the possible changes of metabolic dysfunction-associated fatty liver disease in the liver in patients diagnosed with type II diabetes mellitus.

METHODS

This retrospective study was conducted with a total of 94 patients, 36 females and 58 males, who were hospitalized in the gastroenterohepatology outpatient clinic and diagnosed with hepatosteatosis and type II diabetes mellitus between January 2023 and January 2024. Laboratory tests, height, weight, body mass index, presence of fatty liver disease on ultrasound, and aspartate aminotransferase-platelet ratio index scores of the patients were examined.

RESULTS

The mean serum uric acid level of the patients was 5.26±1.52 mg/dL, and the mean aspartate aminotransferase-platelet ratio index score was 0.26±0.13. The serum uric acid level was found to be associated with the hemoglobin A1c value (p=0.001; p<0.01). However, the aspartate aminotransferase-platelet ratio index scores of the patients did not show a statistically significant difference according to serum uric acid levels (p>0.05).

CONCLUSION

No significant association was observed between serum uric acid and the noninvasive liver test aspartate aminotransferase-platelet ratio index score. Although a causal relationship between metabolic dysfunction-associated fatty liver disease and serum uric acid has been demonstrated in several studies, further research is needed to evaluate possible mechanisms in the liver.

Associations of systemic inflammation and systemic immune inflammation with serum uric acid concentration and hyperuricemia risk: the mediating effect of body mass index

Background

With the development of lifestyle, elevated uric acid and hyperuricemia have become important factors affecting human health, but the biological mechanism and risk factors are still unclear.

Methods

A multi-stage, cross-sectional study of 41,136 adults from the NHANES 2003-2018 was conducted. Serum uric acid concentrations, platelet, neutrophil, lymphocyte, and monocyte counts were measured. The systemic inflammation response (SIRI) index and systemic immune-inflammatory (SII) index were calculated to reflect systemic inflammation and systemic immune inflammation. The height and weight data were obtained to assess body mass index (BMI). Generalized linear models were used to examine the relationships of SIRI and SII with uric acid and hyperuricemia risk, as well as the associations of SIRI and SII with BMI, and BMI with uric acid and hyperuricemia risk. Causal mediation effect model was used to assess the mediating effect of BMI in the relationships of SIRI, and SII with uric acid concentration and hyperuricemia risk.

Results

The prevalence of hyperuricemia in US adults is 19.78%. Positive associations were found in the relationships of SIRI and SII with uric acid level, hyperuricemia risk, and BMI, as well as the relationships of BMI with uric acid and hyperuricemia risk. Causal mediation effect model showed that BMI played an important mediating role in the relationships of SIRI, and SII with uric acid concentration and hyperuricemia risk, with the proportion of mediating effect ranging from 23.0% to 35.9%.

Conclusion

Exposure to higher SIRI and SII is associated with increased uric acid concentration and hyperuricemia risk in adults, and BMI plays an important mediating effect. Reducing systemic inflammation and systemic immune inflammation and proper weight control could be effective ways to reduce hyperuricemia prevalence and related health problems.

Association Between Remnant Cholesterol and Risk of Hyperuricemia: A Cross-Sectional Study

Remnant cholesterol (RC) is closely related to metabolic diseases. Our study aims to explore the relationship between RC and hyperuricemia. This cross-sectional study included 14 568 adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2018 in the United States. RC is calculated by subtracting high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) from total cholesterol (TC). Hyperuricemia is defined by serum uric acid (SUA) levels≥7 mg/dl in men and≥6 mg/dl in women. The independent association between RC and hyperuricemia was evaluated. As the quartile range of RC levels increases, the prevalence of hyperuricemia also rises (7.84% vs. 13.71% vs. 18.61% vs. 26.24%, p<0.001). After adjusting for confounding factors, the fourth quartile of RC was associated with an increased risk of hyperuricemia compared with the first quartile (OR=2.942, 95% CI 2.473-3.502, p<0.001). Receiver Operating Characteristic (ROC) analysis shows that RC outperforms other single lipid indices in hyperuricemia. Further Restricted Cubic Splines (RCS) analysis suggests a nonlinear relationship between RC levels and hyperuricemia. Elevated RC levels were found to be linked to hyperuricemia. Further studies on RC hold promise for both preventing and addressing hyperuricemia.

Triglyceride-glucose index and its additive interaction with ABCG2/SLC2A9 polygenic risk score on hyperuricemia in middle age and older adults: findings from the DLCC and BHMC study

OBJECTIVE

We aim to investigate the joint effect of triglyceride-glucose (TyG) index and polygenic risk scores (PRS) of urate transporter genes ABCG2 and SLC2A9 on hyperuricemia.

METHODS

Baseline data from two prospective population-based cohort studies, including 30,453 individuals aged 50 years or older, were used to analyze the association between TyG index and hyperuricemia. A case-control study was then designed from the cohorts to investigate the interaction between genetic predisposition and TyG index on hyperuricemia among 595 matched pairs. PRS was constructed using 14 single nucleotide polymorphisms located in the ABCG2 and SLCA29 genes.

RESULTS

In both sexes, higher TyG index levels were correlated with elevated serum urate (SUA) levels (p values in both sexes < 0.001). In men, per unit increase of TyG was associated with a 1.44-fold (95% confidence interval [CI]: 1.35-1.55) higher risk of hyperuricemia after adjusted for covariates. In women, this estimate was 1.69 (1.51-1.89). Demonstrated by the restrict cubic spline model, TyG index was both linearly and non-linearly associated with elevated SUA (both p values < 0.001). Association between TyG index and hyperuricemia was stronger among people with higher genetic risk, and vice versa. Compared to people with TyG < 9 and PRS < 2, the odds ratios (ORs) (95% CIs) for hyperuricemia in the TyG <9 but PRS ≥2, TyG ≥9 but PRS < 2, TyG ≥9 and PRS ≥2 groups were 3.30 (1.53-7.14), 3.16 (1.23-8.11) and 7.55 (2.76-20.65), respectively. Additive interaction was also significant, with 57.5% (30.5%-84.4%) of the excess risk attributable to the additive gene-TyG index interaction.

CONCLUSIONS

The impact of genetic predisposition on hyperuricemia was significantly greater among individuals with a higher TyG index. Over 50% of the increased risk can be attributed to the interaction, indicating a crucial synergy between genetic factors and TyG index when estimating hyperuricemia risk.

Urate Levels as a Predictor of the Prevalence and Level of Cardiovascular Risk Factors: An Identificación de La PoBlación Española de Riesgo Cardiovascular y Renal Study

(1) Background: Urate levels lower than the classical cut-off point for defining hyperuricemia can increase cardiovascular risks. The aim of this study is to determine if there is a relationship between different urate levels and classic cardiovascular risk factors (CVRFs). (2) Methods: A cross-sectional study of the inclusion visits of the patients recruited to the IBERICAN study was conducted. The patients were classified into quartiles according to their distribution of urate levels and separated by sex; the three lower points corresponded to normal levels of urate, and the highest quartile was determined according to the classical definition of HU. Multivariate analysis models, adjusted for epidemiological variables, were used to analyze the association of urate levels with CVRFs. (3) Results: The presence of CVRFs was higher across the quartiles of urate, with a continuous increase along the quartiles in both sexes in accordance with body mass index (p < 0.01), waist circumference (p < 0.01), blood pressure (p < 0.01), and LDL cholesterol (p < 0.01). The CV risk estimated by SCORE was associated with an increase along the quartiles in women (p = 0.02). (4) Conclusions: A progressive increase in the frequency of CVRFs, as well as in their levels, was observed across the quartiles of uricemia, which reflects an increase in the CVRs associated with uricemia.

Association between serum uric acid and prediabetes in a normal Chinese population: A cross-sectional study

Cardiovascular events are frequent among individuals with prediabetes. And the relationship between cardiovascular diseases and elevated serum uric acid (SUA) levels has been supported by extensive scientific evidence. However, there remains controversy regarding the correlation between elevated SUA and prediabetes. The aim of this study was to investigate the association between elevated SUA levels and the prevalence of prediabetes and gender differences in the association. A total of 190,891 individuals who participated in health checkups at the Health Promotion Center of Sir Run Run Shaw Hospital of Zhejiang University from January 2017 to December 2021 were included in this cross-sectional study. The health checkups were carried out by trained general practitioners and nurses. The diagnostic criteria for diabetes and prediabetes are defined in the Standards of Medical Care in Diabetes-2022. The association between SUA levels and diabetes and prediabetes was examined based on logistic regression analysis. The dose-response effect between SUA levels and diabetes and prediabetes in both sexes was assessed using a restricted cubic spline (RCS) regression model. Among 190,891 participants, this study included 106,482 males (55.8%) and 84,409 females (44.2%). There were 46,240 (24.2%) patients with prediabetes and 20,792 (10.9%) patients with diabetes. SUA was divided into quartiles (Q). Compared to the SUA Q1 group, the prevalence of prediabetes was elevated in the SUA Q4 group (OR = 1.378, 95% CI = 1.321-1.437), but diabetes risk was decreased in the SUA Q4 group (OR = 0.690, 95% CI = 0.651-0.730). We found that SUA levels were correlated with prediabetes more significantly in male subjects (OR = 1.328, 95% CI = 1.272-1.386) than in female subjects (OR = 1.184, 95% CI = 1.122-1.249) (P for interaction < .001). Higher SUA levels were strongly related to an elevated prevalence of prediabetes but a decreased prevalence of diabetes. The association of SUA in prediabetes was more significant in men.

One-Year Risk Prediction of Elevated Serum Uric Acid Levels in Older Adults: A Longitudinal Cohort Study

Objective

To develop and externally validate a nomogram to predict elevated serum uric acid (SUA) levels in older adults.

Study Design

This is a longitudinal Chinese cohort study.

Methods

A cohort of 2788 older adults was established at Huadong Hospital, followed-up for at least one year, and screened for risk factors for elevated SUA levels. A logistic regression model was built to predict elevated SUA, and its performance was validated.

Results

The risk prediction model showed good discrimination ability in both the development cohort (area under the curve (AUC) = 0.82; 95% confidence interval (CI) =0.79~0.86) and the external validation cohort (AUC=0.76; 95% CI=0.70~0.82). The model was adequately calibrated, and the predictions correlated with the observed outcome (χ 2 = 6.36, P = 0.607). Men were more prone to elevated SUA levels than women were, and a baseline SUA level ≥360 μmol/L was a common risk factor for both males and females. Proteinuria status was an additional risk factor for males, whereas a baseline estimated glomerular filtration rate (eGFR)<60 mL/min·1.73 m2 and diabetes status were additional risk factors for females.

Conclusion

The externally validated nomogram, which is predictive of elevated SUA in older adults, might aid in the detection of individual diseases, the development of preventive interventions and clinical decision-making.

Tryptophan Metabolism-Regulating Probiotics Alleviate Hyperuricemia by Protecting the Gut Barrier Integrity and Enhancing Colonic Uric Acid Excretion

The balance of gut microbiota affects uric acid synthesis and excretion, influencing the development of hyperuricemia. This study aimed to investigate the effects and mechanisms of probiotics on hyperuricemia and adenine- and potassium oxonate-induced colonic damage. After two months of gavage at 109 CFU/day, the probiotic strains Lactobacillus rhamnosus UA260 and Lactobacillus plantarum YU28, identified through in vitro screening, significantly reduced serum uric acid levels in hyperuricemia mice from 109.71 ± 56.33 to 38.76 ± 15.06 and 33.22 ± 6.91 μmol/L, respectively. These strains attenuated inflammatory, repaired gut barrier damage, and enhanced colonic uric acid transporter function, thereby promoting uric acid excretion. Furthermore, the probiotics significantly reshaped gut microbiota by increasing the abundance of beneficial bacteria, including Lactobacillus and Coprococcus, while modulating tryptophan, purine, and riboflavin metabolism. Changes in tryptophan metabolites, specifically indole-3-propionic acid and indole-3-acetic acid, were correlated with xanthine oxidase activity, colonic injury, and the expression of the uric acid transporter protein ABCG2 during treatment. Probiotics intervention activated aryl hydrocarbon receptor pathways. These findings suggest that probiotics alleviate hyperuricemia and colonic inflammatory by regulating gut microbiota composition and tryptophan microbial metabolite pathways. Probiotics that modulate tryptophan microbial metabolism may provide a potential strategy for treating or preventing hyperuricemia.

Effect of the Intake of Solid Block Dairy Products Like Cheese on Serum Uric Acid in Children: A Preliminary Mechanistic Investigation

OBJECTIVE

This study aimed to investigate the relationship between the intake of solid block dairy products like cheese and serum uric acid levels, along with its potential physiological mechanisms.

METHODS

Data for our study were obtained from the Chinese Children and Lactating Women Nutrition and Health Surveillance. Generalized linear models and restricted cubic splines were employed to analyze the relationship between the intake of solid block dairy products like cheese and serum uric acid levels. Two-sample Mendelian randomization (TSMR) analysis was conducted to infer causality, based on a large sample size and robust methodology. Gene Ontology (GO) enrichment analysis was also performed to identify potential biological pathways.

RESULTS

Among all types of dairy products, a significant negative association with serum uric acid levels was observed only for the intake of solid block dairy products like cheese, regardless of covariate adjustment (β = -0.182, p < 0.001). TSMR results supported a negative causal relationship between cheese intake and serum uric acid levels (β = -0.103, 95% CI: -0.149 to -0.057; p = 0.002). The JAK-STAT signaling pathway and autophagy regulation were identified as potential physiological mechanisms underlying this relationship.

CONCLUSIONS

The intake of solid block dairy products like cheese was found to result in decreased levels of serum uric acid, with potential mechanisms involving the JAK-STAT signaling pathway and the regulation of autophagy.

Inverse association between uric acid levels and muscle quality index in adults: a cross-sectional analysis of NHANES 2011-2014

OBJECTIVE

The objective of this study was to delineate the association between serum uric acid (UA) levels and Muscle Quality Index (MQI), assessing muscle strength relative to mass, in adults aged 20 to 59 years.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014, this study examined the association between UA levels and MQI-a ratio of muscle strength to mass. Weighted linear models, adjusted for potential confounders, assessed the relationship, with a generalized additive model (GAM) probing for non-linear patterns. Subgroup analyses and interaction effects were conducted using weighted linear regression across diverse demographic and clinical groups to ensure the robustness and reliability of our findings.

RESULTS

Among 5,277 participants, a significant inverse association was observed between UA levels and MQI, with a 0.08 decrease in MQI per 1 mg/dL increase in UA (95% CI: -0.11 to -0.06, p < 0.001). The negative trend was dose-dependent across UA quartiles, which was most pronounced in the highest quartile (Q4: -0.28, 95% CI: -0.36 to -0.19, p < 0.001). Curve-fitting analysis revealed a consistent inverse relationship without evidence of non-linearity. Stratified analyses reinforced the core findings across all examined subgroups, highlighting the universal relevance of the observed association.

CONCLUSION

Our findings demonstrate a significant inverse association between elevated serum UA levels and MQI, highlighting the potential importance of uric acid management in enhancing muscle quality among young and middle-aged adults. The consistency of this relationship across different subgroups underscores the need for targeted strategies and interventions to manage UA levels. Future research should explore longitudinal impacts and intervention outcomes to further elucidate the potential benefits of uric acid management on muscle health.

Functional identification of soluble uric acid as an endogenous inhibitor of CD38

Excessive elevation or reduction of soluble uric acid (sUA) levels has been linked to some of pathological states, raising another subject that sUA at physiological levels may be essential for the maintenance of health. Yet, the fundamental physiological functions and molecular targets of sUA remain largely unknown. Using enzyme assays and in vitro and in vivo metabolic assays, we demonstrate that sUA directly inhibits the hydrolase and cyclase activities of CD38 via a reversible non-competitive mechanism, thereby limiting nicotinamide adenine dinucleotide (NAD+) degradation. CD38 inhibition is restricted to sUA in purine metabolism, and a structural comparison using methyl analogs of sUA such as caffeine metabolites shows that 1,3-dihydroimidazol-2-one is the main functional group. Moreover, sUA at physiological levels prevents crude lipopolysaccharide (cLPS)-induced systemic inflammation and monosodium urate (MSU) crystal-induced peritonitis in mice by interacting with CD38. Together, this study unveils an unexpected physiological role for sUA in controlling NAD+ availability and innate immunity through CD38 inhibition, providing a new perspective on sUA homeostasis and purine metabolism.

Elucidating the substance basis and pharmacological mechanism of Fufang Qiling granules in modulating xanthine oxidase for intervention in hyperuricemia

ETHNOPHARMACOLOGICAL RELEVANCE

Fufang Qiling granules (FQG), derived from the traditional Qiling Decoction with a longstanding clinical history, is utilized for the treatment of hyperuricemia (HUA). FQG is formulated with a combination of seven Chinese herbs based on the principles of traditional Chinese medicine (TCM) theories. Clinical evidence indicates that FQG exhibits favorable therapeutic effects in reducing uric acid (UA) levels and attenuating renal damage.

AIM OF THIS STUDY

To elucidate the potential active components and pharmacological mechanism of FQG in the treatment of HUA, and to provide an experimental basis for the development of efficient and low-toxicity TCM for HUA treatment.

MATERIALS AND METHODS

A HUA rat model induced by potassium oxonate and adenine was established to initially evaluate the hypouricemic effects of FQG. Chemical analyses were conducted using an ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS). Network pharmacology was used to investigate the active components and mechanism of FQG in the treatment of HUA. Potential Xanthine oxidase (XOD) inhibitors were screened from FQG based on ultrafiltration liquid chromatography and mass spectrometry (UF-LC-MS). Molecular docking, surface plasmon resonance (SPR) and circular dichroism (CD) spectroscopy were applied to validate the interactions between the active components and XOD.

RESULTS

In comparison to the model group, treatment with FQG significantly decreased serum UA, serum creatinine (CREA), serum blood urea nitrogen (BUN), and liver XOD activity. Additionally, the FQG administration notably ameliorated HUA-induced renal injury in rats. Through the pharmacodynamics of the HUA rat models and network pharmacology, it was found that XOD was a key pathway enzyme in UA metabolism. 18 XOD inhibitors were screened from FQG by UF-LC-MS, and 11 compounds with strong affinity were verified by SPR, molecular docking and CD spectroscopy.

CONCLUSION

In summary, flavonoids, organic acids and saponins may be the active components in FQG that alleviate HUA. The primary mechanism of FQG involves inhibiting XOD enzyme activity in the plasma to reduce UA production, alleviating renal tubular epithelial cell necrosis, tubulointerstitial injury, fibrosis, and urate deposition, ultimately exerting a therapeutic effect on HUA.

Network Pharmacology Combined with Experimental Validation to Investigate the Mechanism of the Anti-Hyperuricemia Action of Portulaca oleracea Extract

BACKGROUND/OBJECTIVES

Hyperuricemia (HUA) is a common metabolic disease caused by purine metabolic disorders in the body. Portulaca oleracea L. (PO) is an edible wild vegetable.

METHODS

In this study, the regulatory effect of PO on HUA and its potential mechanism were initially elucidated through network pharmacology and experimental validation.

RESULTS

The results showed that PO from Sichuan province was superior to the plant collected from other habitats in inhibiting xanthine oxidase (XOD) activity. Berberine and stachydrine were isolated and identified from PO for the first time by UPLC-Q-Exactive Orbitrap MS. The potential molecular targets and related signaling pathways were predicted by network pharmacology and molecular docking techniques. Molecular docking showed that berberine had strong docking activity with XOD, and the results of in vitro experiments verified this prediction. Through experimental analysis of HUA mice, we found that PO can reduce the production of uric acid (UA) in the organism by inhibiting XOD activity. On the other hand, PO can reduce the body 's reabsorption of urate and aid in its excretion out of the body by inhibiting the urate transporter proteins (GLUT9, URAT1) and promoting the high expression of urate excretory protein (ABCG2). The results of H/E staining showed that, compared with the positive drug (allopurinol and benzbromarone) group, there was no obvious renal injury in the middle- and high-dose groups of PO extract.

CONCLUSIONS

In summary, our findings reveal the potential of wild plant PO as a functional food for the treatment of hyperuricemia.

Causal relationship between uric acid and stroke: a two-sample mendelian randomization study

Many previous observational studies have disputed whether there is a link between uric acid and stroke. And the causal relationship between uric acid and stroke is unclear. To determine whether there is a causal relationship between uric acid and stroke by using mendelian randomization (MR). Uric acid dataset was obtained from Anna Kottgen et al, with a sample size of 110,347 people, including 2450,548 single nucleotide polymorphisms (SNPs). Stroke pooled data from Malik R et al, publicly available in MEGASTROKE genome-wide association study, included meta-analysis data from 40,585 stroke patients and 406,111 control patients, totaling 8211,693 SNPs. The summary data of genome-wide association study of uric acid and stroke were collected from publicly available online databases. Inverse variance weighting was used to determine the causal relationship between uric acid and stroke. MR-Egger and weighted median model were used for supplementary analysis. Results were then analyzed for heterogeneity, pleiotropy, and sensitivity to ensure no statistical pleiotropy and to reduce bias. A total of 27 SNPs were included in this study after the disequilibrium instrumental variables were excluded. Check the PhenoScanner database for SNPs associated with confounders. In the end, a total of 8 SNPs were excluded. Two SNPs were excluded because the correction direction was the same. Since the F statistic is >10, rs10761587 and rs1825043 are excluded. Finally, 15 SNPs were selected as uric acid instrumental variables. Inverse variance weighting-fixed effect model suggested that there was no causal relationship between uric acid and stroke (odds ratio = 1.004, 95% confidence interval = 0.940, 1.072). MR-Egger and weighted median model also showed the same result. In addition, the results of this study were robust without heterogeneity and pleiotropy. This MR study suggests no support of a causal relationship between uric acid and stroke.

A comprehensive review on recent xanthine oxidase inhibitors of dietary based bioactive substances for the treatment of hyperuricemia and gout: Molecular mechanisms and perspective

Hyperuricemia (HUA) has attained a considerable global health concern, related to the development of other metabolic syndromes. Xanthine oxidase (XO), the main enzyme that catalyzes xanthine and hypoxanthine into uric acid (UA), is a key target for drug development against HUA and gout. Available XO inhibitors are effective, but they come with side effects. Recent, research has identified new XO inhibitors from dietary sources such as flavonoids, phenolic acids, stilbenes, alkaloids, polysaccharides, and polypeptides, effectively reducing UA levels. Structural activity studies revealed that -OH groups and their substitutions on the benzene ring of flavonoids, polyphenols, and stilbenes, cyclic rings in alkaloids, and the helical structure of polysaccharides are crucial for XO inhibition. Polypeptide molecular weight, amino acid sequence, hydrophobicity, and binding mode, also play a significant role in XO inhibition. Molecular docking studies show these bioactive components prevent UA formation by interacting with XO substrates via hydrophobic, hydrogen bonds, and π-π interactions. This review explores the potential bioactive substances from dietary resources with XO inhibitory, and UA lowering potentials detailing the molecular mechanisms involved. It also discusses strategies for designing XO inhibitors and assisting pharmaceutical companies in developing safe and effective treatments for HUA and gout.

Antidiabetic and Antigout Properties of the Ultrasound-Assisted Extraction of Total Biflavonoids from Selaginella doederleinii Revealed by In Vitro and In Silico Studies

In this study, the extraction, purification and metabolic enzyme inhibition potential of Selaginella doederleinii were investigated. In order to extract the total biflavonoids from S. doederleinii (SDTBs), the optimum extraction process was obtained by optimizing the ultrasonic extraction parameters using response-surface methodology. This resulted in a total biflavonoid content of 22.26 ± 0.35 mg/g. Purification of the S. doederleinii extract was carried out using octadecylsilane (ODS), and the transfer rate of the SDTBs was 82.12 ± 3.48% under the optimum purification conditions. We determined the effect of the SDTBs on α-glucosidase (AG), α-amylase and xanthine oxidase (XOD) and found that the SDTBs had an extremely potent inhibitory effect on AG, with an IC50 value of 57.46 μg/mL, which was much lower than that of the positive control. Meanwhile, they also showed significant inhibition of XOD and α-amylase, with IC50 values of 289.67 μg/mL and 50.85 μg/mL, respectively. In addition, molecular docking studies were carried out to understand the nature of the action of the biflavonoids on AG and XOD. The results showed that robustaflavone had the lowest binding energy to AG (-11.33 kcal/mol) and XOD (-10.21 kcal/mol), while, on the other hand, amentoflavone showed a good binding affinity to AG (-10.40 kcal/mol) and XOD (-9.962 kcal/mol). Moreover, molecular dynamics simulations verified the above results.

Relationship between serum uric acid levels and periodontitis-A cross-sectional study

OBJECTIVES

Whether there is an association between serum uric acid level (sUA) and periodontitis remains unclear. The aim of this study was to investigate the association between moderate/severe periodontitis and sUA in US adults.

MATERIALS AND METHODS

A total of 3398 participants were included in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. The independent variable was sUA and the dependent variable was periodontitis. SUA for continuous variables, periodontitis as classification variables. Covariate including social demographic variables, life style, systemic diseases, etc. Multiple linear regression models were used to investigate the distribution of differences in covariates between different independent groups. To investigate the association between serum uric acid levels and moderate/severe periodontitis, three models were used (Model 1: unadjusted model; Model 2: adjusted for age, sex, and race/ethnicity; Model 3: adjusted for age, sex, race/ethnicity, education, household income/poverty ratio, smoking behavior, alcohol consumption, dental floss frequency, obesity, hypertension, diabetes, high cholesterol, hyperlipidemia, and sleep disorders).

RESULTS

Among the 3398 patients, 42.5% had moderate/severe periodontitis. Multivariate logistic regression analysis showed that sUA was significantly associated with moderate/severe periodontitis (OR = 1.10, 95%CI: (1.03, 1.16), P = 0.0020) after adjusting for potential confounding factors. In addition, it may vary by race/ethnicity and gender. The association between sUA levels and the prevalence ofperiodontitis was U-shaped in women and non-Hispanic blacks.

CONCLUSION

sUA level is associated with moderate to severe periodontitis. However, the association between sUA levels and the occurrence of periodontitis in women and non-Hispanic blacks followed a U-shaped curve.

CLINICAL RELEVANCE

sUA may directly or indirectly contribute to the global burden of periodontal disease, but there is little evidence that sUA is directly related to periodontitis.This study further supports that high uric acid levels are closely related to periodontitis and may contribute to the control of periodontitis. It also provides new insights into whether it can be used as an indicator to assess the risk or progression of periodontitis. More studies are needed to confirm the relationship between sUA and periodontitis.

The Causal Effect of Urate Level on Female Infertility: A Mendelian Randomization Study

BACKGROUND/OBJECTIVE

This study aimed to investigate the causal relationship between urate level and female infertility using Mendelian randomization (MR) analysis.

METHODS

To identify instrumental variables, we selected independent genetic loci associated with serum urate levels in individuals of European ancestry, utilizing data from large-scale genome-wide association studies (GWAS). The GWAS dataset included information on serum urate levels from 288,649 CKDGen participants. Female infertility data, including different etiologic classifications, consisted of 13,142 female infertility patients and 107,564 controls. We employed four MR methods, namely inverse variance weighted (IVW), MR-Egger, weighted median, and weighted model, to investigate the causal relationship between urate levels and female infertility. The Cochran Q-test was used to assess heterogeneity among single nucleotide polymorphisms (SNPs), and the MR-Egger intercept test was employed to evaluate the presence of horizontal pleiotropy. Additionally, a "leave-one-out" sensitivity analysis was conducted to examine the influence of individual SNPs on the MR study.

RESULTS

The IVW analysis demonstrated that elevated serum urate levels increased the risk of female infertility (odds ratio [OR] = 1.18, 95% confidence interval [CI]: 1.07-1.33). Furthermore, serum urate levels were found to be associated with infertility due to cervical, vaginal, or other unknown causes (OR = 1.16, 95% CI: 1.06-1.26), also confirmed by other methods. Heterogeneity among instrumental variables was assessed using Cochran's Q-test (p < 0.05), so a random-effects IVW approach was employed in the effects model. The MR-Egger intercept test indicated no presence of horizontal pleiotropy. A "leave-one-out" sensitivity analysis was conducted, demonstrating that no individual SNP had a substantial impact on the overall findings.

CONCLUSIONS

In the European population, the urate level is significantly and causally associated with an increased risk of female infertility.

Multimodal Machine Learning-Based Marker Enables Early Detection and Prognosis Prediction for Hyperuricemia

Hyperuricemia (HUA) has emerged as the second most prevalent metabolic disorder characterized by prolonged and asymptomatic period, triggering gout and metabolism-related outcomes. Early detection and prognosis prediction for HUA and gout are crucial for pre-emptive interventions. Integrating genetic and clinical data from 421287 UK Biobank and 8900 Nanfang Hospital participants, a stacked multimodal machine learning model is developed and validated to synthesize its probabilities as an in-silico quantitative marker for hyperuricemia (ISHUA). The model demonstrates satisfactory performance in detecting HUA, exhibiting area under the curves (AUCs) of 0.859, 0.836, and 0.779 within the train, internal, and external test sets, respectively. ISHUA is significantly associated with gout and metabolism-related outcomes, effectively classifying individuals into low- and high-risk groups for gout in the train (AUC, 0.815) and internal test (AUC, 0.814) sets. The high-risk group shows increased susceptibility to metabolism-related outcomes, and participants with intermediate or favorable lifestyle profiles have hazard ratios of 0.75 and 0.53 for gout compared with those with unfavorable lifestyles. Similar trends are observed for other metabolism-related outcomes. The multimodal machine learning-based ISHUA marker enables personalized risk stratification for gout and metabolism-related outcomes, and it is unveiled that lifestyle changes can ameliorate these outcomes within high-risk group, providing guidance for preventive interventions.

Nonlinear association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and hyperuricemia in cancer patients: evidence from NHANES 2007-2018

BACKGROUND

Evidence shows that cancer patients are more likely to have hyperuricemia (HUA) compared to the general population, with lipid metabolism playing a significant role. However, it is still unclear whether there is a non-linear relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and HUA in these patients. This study aims to explore the association between NHHR and HUA in cancer patients.

METHODS

This study included participants from the NHANES database from 2007 to 2018. We used multivariable logistic regression, restricted cubic splines (RCS) analysis, and subgroup analysis to examine the association between NHHR and HUA and gout in cancer patients, as well as to investigate differences in this association among specific subgroups.

RESULTS

A total of 2826 participants were included, with a HUA prevalence of 24.30%. Weighted multivariable logistic regression showed that for each unit increase in NHHR, the odds of HUA in cancer patients increased by 16% (95% confidence interval [CI]: 1.06, 1.29, P = 0.002). When NHHR was divided into tertiles, those in the highest tertile (Q3) had a 1.84 times higher odds of developing HUA compared to those in the lowest tertile (Q1) (95% CI: 1.32, 2.58, P < 0.001). However, there was no significant association with gout. RCS analysis further revealed a significant non-linear positive association, particularly among males. Subgroup analysis and interaction tests indicated a stronger association in cancer patients who did not have a history of stroke.

CONCLUSION

There is a non-linear association between NHHR and HUA in cancer patients.

The SGLT2 inhibitor dapagliflozin ameliorates renal fibrosis in hyperuricemic nephropathy

Hyperuricemic nephropathy (HN) is a global metabolic disorder characterized by uric acid (UA) metabolism dysfunction, resulting in hyperuricemia (HUA) and tubulointerstitial fibrosis (TIF). Sodium-dependent glucose transporter 2 inhibitor, dapagliflozin, has shown potential in reducing serum UA levels in patients with chronic kidney disease (CKD), though its protective effects against HN remain uncertain. This study investigates the functional, pathological, and molecular changes in HN through histological, biochemical, and transcriptomic analyses in patients, HN mice, and UA-stimulated HK-2 cells. Findings indicate UA-induced tubular dysfunction and fibrotic activation, which dapagliflozin significantly mitigates. Transcriptomic analysis identifies estrogen-related receptor α (ERRα), a downregulated transcription factor in HN. ERRα knockin mice and ERRα-overexpressed HK-2 cells demonstrate UA resistance, while ERRα inhibition exacerbates UA effects. Dapagliflozin targets ERRα, activating the ERRα-organic anion transporter 1 (OAT1) axis to enhance UA excretion and reduce TIF. Furthermore, dapagliflozin ameliorates renal fibrosis in non-HN CKD models, underscoring the therapeutic significance of the ERRα-OAT1 axis in HN and CKD.

WWC1 upregulation accelerates hyperuricemia by reduction in renal uric acid excretion through Hippo signaling pathway

Hyperuricemia (HUA) is a metabolic disorder characterized by elevated serum uric acid (UA), primarily attributed to the hepatic overproduction and renal underexcretion of UA. Despite the elucidation of molecular pathways associated with this underexcretion, the etiology of HUA remains largely unknown. In our study, using by Uox knockout rats, HUA mouse, and cell line models, we discovered that the increased WWC1 levels were associated with decreased renal UA excretion. Additionally, using knockdown and overexpression approaches, we found that WWC1 inhibited UA excretion in renal tubular epithelial cells. Mechanistically, WWC1 activated the Hippo pathway, leading to phosphorylation and subsequent degradation of the downstream transcription factor YAP1, thereby impairing the ABCG2 and OAT3 expression through transcriptional regulation. Consequently, this reduction led to a decrease in UA excretion in renal tubular epithelial cells. In conclusion, our study has elucidated the role of upregulated WWC1 in renal tubular epithelial cells inhibiting the excretion of UA in the kidneys and causing HUA.

Hyperuricemia and gout enhanced the risk of long-term mortality in hypertension: insights from the National Health and Nutrition Examination Survey 2007-2018

BACKGROUND

Asymptomatic hyperuricemia (HUA) and normouricemic gout are common in clinic but recommendations for them in hypertension management are absent. The present study aims to simultaneously evaluate the effect of HUA and gout on long-term mortality in hypertension.

METHODS

Individuals from 2007-2018 National Health and Nutrition Examination Survey were enrolled. Hazard ratios and 95% confidence intervals (CIs) were calculated with the aid of the Cox proportional-hazards model. The restricted cubic spline (RCS) analysis was made to show the dose-response relationship between uric acid and mortality. All-cause mortality and cardiovascular mortality were compared using the Kaplan-Meier curve with a log-rank test.

RESULTS

Thirty thousand eight hundred and nineteen eligible individuals were included, of which 5841 suffered from HUA and 1476 suffered from gout. During a median follow-up of 7.25 (95% CI 7.18-7.32) years, 2924 (6.8%) patients died, including 722 (1.6%) cases of cardiovascular death. Hypertensive patients with HUA and gout showed 1.34 and 1.29 times higher all-cause mortality compared with those without HUA or gout. For hypertensive patients without gout, HUA was significantly associated with higher risk of all-cause [1.27 (1.13, 1.43)] and cardiovascular [1.80 (1.44, 2.24)] mortality compared with normouricemia. However, for hypertensive patients without HUA, gout was associated with a higher mortality but not statistically significant. A J-shaped relationship was found between serum uric acid and mortality.

CONCLUSION

HUA and gout are additive risk factors for all-cause and cardiovascular mortality in hypertension. Furthermore, asymptomatic HUA is significantly associated with poor long-term prognosis but normouricemic gout is not.

Association between vitamin B1 intake and hyperuricemia in adults

Studies investigating the relationship between dietary vitamin B1 intake and risk of Hyperuricemia (HU) are scarce, the present study aimed to examine the association of dietary vitamin B1 intake and HU among adults. This cross-sectional study included 5750 adults whose data derived from National Health and Nutrition Examination Survey (NHANES) from March 2017 to March 2020. The dietary intake of vitamin B1 was assessed using 24-h dietary recall interviews. The characteristics of study participants were grouped into five levels according to the levels of vitamin B1 quintile. Multivariate logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of HU, according to the vitamin B1 intake quintile for male and female separately. The dose-response relationship was determined by the restricted cubic spline (RCS). Smoothed curve fitting was used to assess serum uric acid concentration versus dietary vitamin B1 intake in the study population. The prevalence of hyperuricemia was 18.90% (20.15% and 17.79% for males and females, respectively) in the United States from March 2017 to March 2020. Multiple logistic regression analyses showed that in the male population, the HU ratio (OR) of vitamin B1 intake in Q2 to Q5 compared with the lowest quintile (Q1) was 0.75 (95% CI 0.52, 1.09), 0.70 (95% CI 0.48, 1.02), 0.66 (95% CI 0.44, 0.99) and 0.55 (95% CI 0.34, 0.90). The P for trend was 0.028. In women, the ORs for vitamin B1 intake Q2 to Q5 were 0.87 (95% CI 0.64, 1.19), 0.97 (0.68-1.38), 1.05 (0.69-1.60) and 0.75 (0.42-1.34), respectively. The P for trend was 0.876. The RCS curve revealed a linear relationship between vitamin B1 intake and the risk of hyperuricemia in men (P nonlinear = 0.401). Smoothed curve fitting demonstrated a negative association between vitamin B1 intake and serum uric acid concentration in men, whereas there was no significant association between dietary vitamin B1 intake and the risk of hyperuricemia in women. In the US adult population, dietary vitamin B1 intake was negatively associated with hyperuricemia in males.