El ácido úrico es un predictor de desarrollo de diabetes mellitus tipo 2 en la población general

doi:10.1016/S1575-0922(09)70554-6

Endocrinología y Nutrición

Volume 56, Issue 2, February 2009, Pages 66-70

https://doi.org/10.1016/S1575-0922(09)70554-6 Get rights and content

Introducción

El ácido úrico ha sido relacionado con elementos de riesgo cardiovascular, y hay autores que lo consideran un factor de riesgo, aunque otros lo consideran un marcador. Ante esta situación, nos planteamos estudiar la asociación entre las concentraciones plasmáticas de ácido úrico y el riesgo de diabetes.

Material y métodos

Estudio prospectivo con 8 años de seguimiento de 411 sujetos de población general sin alteración del metabolismo de los hidratos de carbono valorada mediante sobrecarga oral de glucosa. Se midió, a todos los sujetos, las siguientes variables biológicas al comienzo y al final del estudio: ácido úrico, triglicéridos, colesterol, colesterol de las lipoproteínas de alta densidad, índice de masa corporal, índice cintura/cadera, glucosa e insulina en plasma. Se clasificó a los sujetos en función de la concentración de ácido úrico plasmático, se estableció el punto de corte en el percentil 33 (varones, 291,45 μmol/l y mujeres, 208,18 μmol/l).

Resultados

Los sujetos con concentraciones plasmáticas de ácido úrico por encima del percentil 33 presentaban un peor perfil lipídico y antropométrico. Estos sujetos además presentaban riesgo de alteraciones del metabolismo de los hidratos de carbono de 1,73 (intervalo de confianza del 95%, 1,04-2,8) al cabo de los 8 años de seguimiento. No se encontraron diferencias significativas en la edad entre estos dos grupos ni en el resto de las variables estudiadas.

Conclusiones

El incremento de las concentraciones plasmáticas de ácido úrico en respuesta a un posible aumento crónico del estrés oxidativo podría ser un predictor de futuros desórdenes o complicaciones que sufren los individuos sanos, como es la diabetes tipo 2.

Introduction

Abnormal uric acid levels are considered by some to be a risk factor for metabolic disorders, whereas others consider it to be just a marker. We therefore examined the association between plasma uric acid concentrations and the risk of type 2 diabetes mellitus.

Material and methods

We undertook a prospective, 8-year study of 411 persons from the general population with no carbohydrate metabolism disorder at the start of the study evaluated by oral glucose overload. The following variables were measured at the beginning and end of the study: uric acid, triglycerides, cholesterol, high-density lipoprotein cholesterol, glucose and insulin in plasma, body mass index and waist-to-hip ratio. The participants were classified according to their plasma uric acid concentration, with a cut-off at the 33rd percentile (men, 291.45 and women, 208.18 μmol/l).

Results

Participants with plasma uric acid concentrations above the 33rd percentile at the start of the study had worse lipid and anthropometric profiles. These persons were at greater risk for carbohydrate disorder at the end of the 8- year follow-up study (relative risk, 1.73; 95% confidence interval, 1.04-2.8). No significant differences were found in age or in the remaining variables studied between these two groups.

Conclusions

Increased uric acid levels in response to a possible chronic increase in oxidative stress may predict future disorders or complications such as type 2 diabetes in otherwise healthy persons.

Section snippets

INTRODUCCIÓN

En el momento actual vivimos un interesante debate que consiste en demostrar si las cifras elevadas de ácido úrico son un marcador o un factor de riesgo cardiovascular. El ácido úrico (AU) plasmático se relaciona con factores de riesgo cardiovascular, especialmente con la hipertensión y la diabetes mellitus¹. El AU está considerado como un marcador de riesgo de enfermedad cardiovascular, cerebrovascular e infarto de miocardio, al comparar a pacientes y sujetos con concentraciones normales de AU

SUJETOS Y MÉTODO

Este estudio se realizó en Pizarra, una ciudad de la provincia de Málaga, fundada en 1818 y con una población de origen caucásica homogénea.

Se estudió a 411 personas (el 34%, varones), con edades entre 18 y 65 años, sin alteración en el metabolismo de los hidratos de carbono tras una sobrecarga oral de glucosa, seleccionados del censo municipal, el grupo constituyó una submuestra del estudio Pizarra⁸. Se excluyó a mujeres embarazas, pacientes hospitalizados o aquellos con desórdenes psíquicos.

RESULTADOS

La incidencia de trastornos del metabolismo de los hidratos de carbono en el estudio Pizarra se ha documentado⁸. El análisis del subgrupo de 411 sujetos sin anomalías en el metabolismo de los hidratos de carbono al inicio del estudio muestra que 66 (25,5%) de los 259 sujetos con concentraciones plasmáticas de ácido úrico mayores que el percentil 33 presentaban, a los 8 años de seguimiento, algún desorden en el metabolismo de los hidratos de carbono (alteración de la glucemia en ayunas [IFG],

DISCUSIÓN

En este estudio hemos demostrado que hay una relación directa entre las concentraciones plasmáticas de ácido úrico y el riesgo de desarrollar alteraciones en el metabolismo de los hidratos de carbono en un grupo de sujetos de población general sana. También hemos encontrado una estrecha relación entre las concentraciones de ácido úrico y los factores clásicos de riesgo cardiovascular.

Clasificando a los sujetos en función de las concentraciones plasmáticas de ácido úrico, observamos, al inicio

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Models Predictive of Metabolic Syndrome Components in Obese Pediatric Patients
2016, Archives of Medical Research
Citation Excerpt :
Second, we did not include the pubertal classification; therefore, the pubertal status influencing MetS traits is unknown. Dehghan and collaborators conducted a study of 462 adult patients, finding that the incidence of DM2 was higher in individuals with high SUA levels and concluded that hyperuricemia is a risk factor for the development of DM2, consistent with another study of Hispanic adults (45,46). These reports highlight the importance of considering hyperuricemia as a factor that could guide our search for other associated comorbidities in obese pediatric patients.
Components of metabolic syndrome (MetS) are complications caused by abdominal obesity and insulin resistance (IR). Diagnosis of MetS by clinical indicators could help to identify patients at risk of cardiovascular disease and type 2 diabetes. We undertook this study to propose predictive indicators of MetS in obese children and adolescents.
A cross-sectional study was carried out. After obtaining informed consent and the registration of the study with an institutional research committee, 172 obese patients from an Obesity Clinic, aged 6–15 years, were included. Variables included were waist circumference (WC), glucose, high-density lipoprotein (HDL), triglycerides (TGL), blood pressure, insulin resistance (by homeostatic model assessment HOMA-index), acanthosis nigricans (AN), uric acid, serum glutamic oxaloacetic transaminase (GOT) and alanine transaminase, and hepatic sonogram. International standards for age and sex variables were used. Multivariate analysis was applied.
Variables predicted components of MetS in children: HOMA-IR (insulin resistance by HOMA index) was increased by 2.4 in hepatic steatosis, by 0.6 for each unit of SUA (serum uric acid), and by 0.009 for every mg/dL of triglycerides. In adolescents, every cm of waist circumference increased systolic blood pressure by 0.6 mmHg, and each unit of SUA increased it by 2.9 mmHg.
Serum uric acid and waist circumference are useful and accessible variables that can predict an increased risk of cardiovascular disease in obese pediatric patients.
Hyperuricemia and metabolic syndrome in children with overweight and obesity
2012, Endocrinologia y Nutricion
Citation Excerpt :
Zoppni et al. in a prospective study with 2726 patients with type 2 diabetes suggested that high concentrations of uric acid were predictive of cardiovascular mortality in patients with type 2 diabetes mellitus.28,29 In another study on 462 subjects who had been free of disease for 10 years, Dehghan et al. found that the incidence of type 2 diabetes mellitus was higher in subjects with high uric acid levels and concluded that hyperuricemia was a risk factor for the development of such disease.30–32 In our study, we cannot infer a causal relationship between hyperuricemia and the various parameters that make up the metabolic syndrome.
To study the prevalence of hyperuricemia in children with overweight or obesity and analyze the relation with metabolic syndrome and the diseases that define it.
This is a cross-sectional prevalence study in 148 children recruited from pediatric endocrinology consultation, with overweight or obesity (12 ± 3 years, 48% boys, BMI 31.8 ± 6.1). We measured BMI, waist-height, waist circumference, blood pressure with standard instrumentation and glucose (fasting and after overload with 75 g), insulin resistance, cholesterol HDL, triglycerides and uric acid.
The prevalence of hyperuricemia was 53%. Patients with hyperuricemia had greater BMI (33.9 vs 30.6, p = 0.003), plus waist circumference (101.4 vs 91.1 cm, p < 0.001), higher blood pressure: systolic (123.4 vs 111.9 mm Hg, p < 0.001), diastolic (78.2 vs 68.7 mm Hg, p < 0.001). They presented greater blood glucose after overload oral glucose (107.5 vs 100.7 mg/dl, p = 0.03), insulin was higher (29.2 vs 20.7 mg/dl, p = 0.001) as well as HOMA IR (6.5 vs 4.4, p < 0.001) and HDL levels were lower (49.5 vs 54.4 mg/dl, p = 0.02).
Uric acid's level which most is the likely diagnosis of metabolic syndrome corresponds to 5.4 mg/dl in our sample (sensitivity: 64% and specificity 62%).
The prevalence of hyperuricemia in children with overweight and obesity is high. In the group of patients with obesity and hyperuricemia, we found out that the parameters measured to diagnose with metabolic syndrome were less favorable. Uric acid's level from where there is a higher possibility to see metabolic syndrome is 5.4 mg/dl.
Estudiar la prevalencia de hiperuricemia en niños con sobrepeso u obesidad y analizar la relación con el síndrome metabólico y las enfermedades que lo definen.
Se realizó un estudio de prevalencia transversal en 148 niños con sobrepeso u obesidad(12 ± 3 años, 48% chicos, IMC 31,8 ± 6,1) reclutados de una consulta de endocrinología pediátrica. Se determinaron el IMC, la cintura-talla, el perímetro de la cintura, la presión arterial con el equipo habitual y la glucosa (en ayunas y tras sobrecarga con 75 g), la resistencia a la insulina, el colesterol HDL, los triglicéridos y el ácido úrico.
La prevalencia de hiperuricemia era del 53%. Los pacientes con hiperuricemia tenían valores superiores de IMC (33,9 frente a 30,6; p = 0,003), perímetro de cintura (101,4 frente a 91,1 cm; p < 0,001) y presión arterial sistólica (123,4 frente a 111,9 mmHg; p < 0,001) y diastólica (78,2 frente a 68,7 mmHg; p < 0,001). Mostraban además una glucemia más alta después de la sobrecarga oral de glucosa (107,5 frente a 100,7 mg/dl; p = 0,03), valores superiores de insulina (29,2 frente a 20,7 mg/dl; p = 0,001) y HOMA IR (6,5 frente a 4,4; p < 0,001) y concentraciones más bajas de HDL (49,5 frente a 54,4 mg/dl; p = 0,02).
El valor de ácido úrico correspondiente con mayor probabilidad al diagnóstico de síndrome metabólico en nuestra muestra era de 5,4 mg/dl (sensibilidad del 64% y especificidad del 62%).
La prevalencia de hiperuricemia en niños con sobrepeso y obesidad es alta. En el grupo de pacientes con obesidad e hiperuricemia hallamos que los parámetros determinados para diagnosticar el síndrome metabólico eran menos favorables. La concentración de ácido úrico a partir de la cual existe una mayor posibilidad de encontrar síndrome metabólico es de 5,4 mg/dl.
Correlation between uric acid levels and mortality in patients with ischemic cerebrovascular accident in an academic center
2019, Medicina Interna de Mexico
Association between metabolic syndrome and the serum uric acid: A cohort study
2018, Clinical Laboratory
Uric acid and diabetes: Is there a link?
2013, Current Pharmaceutical Design
Effect of pioglitazone on serum uric acid levels in newly diagnosed, drug-naïve patients with type 2 diabetes
2013, Endocrine Research

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^☆: Este estudio ha sido financiado por el Fondo de Investigaciones Sanitarias (FIS) Centros de Investigación Biomédica en Red (CIBER, CB06/03/0018) del Instituto de Salud Carlos III, SAF 2006/12894 del MCYT y el proyecto FIS 05/1307 del Instituto de Salud Carlos III, Madrid.

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OriginalesEl ácido úrico es un predictor de desarrollo de diabetes mellitus tipo 2 en la población generalUric acid predicts type 2 diabetes mellitus in the general population☆

Introducción

Material y métodos

Resultados

Conclusiones

Introduction

Material and methods

Results

Conclusions

Section snippets

INTRODUCCIÓN

SUJETOS Y MÉTODO

RESULTADOS

DISCUSIÓN

Nutr Metab Cardiovasc Dis

Ann Epidemiol

Regul Toxicol Pharmacol

Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: The urate redox shuttle

Nutr Metab (Lond)

Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study

Ann Intern Med

Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study

Arch Intern Med

Studien ueber das Hypertonie-Hyperglyka “mie-Hyperurika” miesyndrom

Zentralblatt fuer Innere Medizin

Banting lecture 1988. Role of insulin resistance in human disease

Diabetes

Changes in insulin and lipid metabolism in males with asymptomatic hyperuricaemia

J Intern Med

Incidence of type 2 diabetes in southern Spain (Pizarra Study)

Eur J Clin Invest