Prevalence and metabolic factors of hyperuricemia in an elderly agricultural and fishing population in Taiwan.
Because hyperuricemia is a critical health problem, the Wilson criteria are used for its routine screening. This requires a thorough understanding of the course of the disease, because patients may present with either a recognizable latent or early symptomatic stage. The clinical tests used for screening are easy to perform and interpret, and are reliable, accurate, acceptable, sensitive, and specific. After screening, an accepted treatment should be started in the event of positive results. From the viewpoint of preventive medicine, regional awareness of the background morbidity of hyperuricemia as well as exploration of the complete spectrum of demographic and biological markers likely associated with hyperuricemia are essential. Sex differences in the prevalence of and risk factors associated with hyperuricemia among specific elderly occupational populations require clarification. Thus, in this study, we aimed to explore the potential condition-related sex differences to understand the overall pathogenesis of hyperuricemia among the elderly agricultural and fishing population in Taipei, Taiwan.
PATIENTS AND METHODS
This population-based cross-sectional study included a total of 4,372 healthy elderly agricultural and fishing professionals (2,766 males, 1,606 females; mean age 74.4 [+ or -] 6.6 years; range 65.0 to 90.3 years) voluntarily admitted to New Taipei City Hospital in Taipei, Northern Taiwan for an annual physical exam between January and December 2010.
Complete details regarding the study design and execution have been described elsewhere.  Fasting blood samples were drawn from participants through venipuncture by well-trained clinical nurses. Overnight-fasting serum and plasma samples were frozen (-20 [degrees]C) until analysis. Face-to-face interviews along with a structured questionnaire were administered by the nurses during each visit.
Hyperuricemia was diagnosed when serum uric acid levels were [greater than or equal to] 7 mg/dL for males or [greater than or equal to] 6 mg/dL for females [6,7] In addition, participants with [greater than or equal to] 40 U/L serum alanine amino transferase (ALT) were classified as those with elevated ALT levels.  The definitions of type 2 diabetes and hypertension were based on 1999 World Health Organization criteria and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, respectively. [8,9] Participants with a history of type 2 diabetes or hypertension and regularly receiving medication were classified as known cases. The following clinical conditions were used for defining obesity: high body mass index ([greater than or equal to] 25 kg/[m.sup.2]), hypercholesterolemia (total cholesterol [greater than or equal to] 200 mg/dL), hypertriglyceridemia (triglycerides [greater than or equal to] 200 mg/dL), low high-density lipoprotein (HDL) <35 mg/dL, high blood urea nitrogen (BUN) [greater than or equal to] 20 mg/dL, and high creatinine levels ([greater than or equal to] 1.4 mg/dL).  The study protocol was approved by the Fu-Jen Catholic University Ethics Committee. A written informed consent was obtained from each patient. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Statistical analysis was performed using SAS (Statistical Analysis System) for Windows version 9.2 (SAS Institute Inc., Cary, NC, USA). A two-sample independent t test was used to assess differences in the mean values of continuous variables. Crude and sex- and age-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Multiple logistic regression analysis was used to evaluate the independence of hyperuricemia-related factors. A p value of <0.05 was considered statistically significant.
In this study, the overall prevalence of hyperuricemia in the screened population was 30.4%, which significantly increased with increasing participant age according to the chi-square trend test results (p<0.0001). The prevalence of hyperuricemia in males was not significantly higher than that in females (30.2% versus 30.6%; p=0.78, Chi-square test). Data were stratified into four broad age groups; females exhibited a higher prevalence of hyperuricemia than males in all age groups, with the exception of the 65-74-year-old group. The age-specific prevalence of hyperuricemia displayed a significant positive association with age according to the Chi-square trend test results for males (p = 0.015) and females (p = 0.008) (Table 1).
The results of the comparison of various test characteristics and their potential association with specific (serum uric acid) class values (either hyperuricemia or normal) for participants aged [greater than or equal to] 65 years are listed in Table 2. According to the results of the two-sample independent t test, the associated factors significantly associated with hyperuricemia included age (yes, 75.1 [+ or -] 6.7 years, versus no, 73.0 [+ or -] 6.5 years), body mass index (yes, 28.0 [+ or -] 6.9 kg/[m.sup.2], versus no, 25.9 [+ or -] 5.3 kg/[m.sup.2]), fasting plasma glucose (yes, 102.7 [+ or -] 28.6 mg/dL, versus no, 99.5 [+ or -] 27.3 mg/dL), triglyceride (yes, 153.1 [+ or -] 92.7 mg/dL, versus no, 121.8 [+ or -] 80.6 mg/dL), HDL (yes, 50.8 [+ or -] 14.3 mg/dL, versus no, 55.8 [+ or -] 15.1 mg/dL), BUN (yes, 19.2 [+ or -] 7.1 mg/dL, versus no, 17.1 [+ or -] 4.7 mg/dL), creatinine (yes, 1.1 [+ or -] 0.6 mg/dL, versus no, 0.9 [+ or -] 0.3 mg/dL), and ALT (yes, 33.2 [+ or -] 26.1 U/L, versus no, 30.6 [+ or -] 21.1 U/L) levels. In addition, to examine whether sex-related differences in hyperuricemia are related to differences in clinical parameters, Table 2 also shows that triglyceride, BUN, creatinine, and ALT levels were significant factors associated with hyperuricemia in both males and females.
The crude and age- and sex-adjusted ORs for the association between relevant risk factors and hyperuricemia are presented in Table 3. Compared with individuals who exhibited normal uric acid levels, those with hyperuricemia revealed a more pronounced prevalence of obesity (adjusted OR=1.53, 95% CI: 1.32-1.77), type 2 diabetes (adjusted OR=1.16, 95% CI: 1.01-1.33), hypercholesterolemia (adjusted OR=1.22, 95% CI: 1.06-1.41), hypertriglyceridemia (adjusted OR=1.78, 95% CI: 1.52-2.09), low HDL (adjusted OR=1.54, 95% CI: 1.28-1.86), high BUN (adjusted OR=1.57, 95% CI: 1.34-1.85), high creatinine (adjusted OR=3.09, 95% CI: 2.26-4.23), and high ALT levels (adjusted OR=1.36, 95% CI: 1.14-1.64) after adjustment for sex and age.
The effects of independent associated risk factors on hyperuricemia were further examined using a multiple logistic regression model. After adjusting for confounding factors, age (OR=1.02, 95% CI: 1.01-1.03), obesity (yes versus no, OR=1.53, 95% CI: 1.32-1.77), type 2 diabetes (yes versus no, OR=1.16, 95% CI: 1.01-1.33), hypercholesterolemia (yes versus no, OR=1.22, 95% CI: 1.06-1.41), hypertriglyceridemia (yes versus no, OR=1.78, 95% CI: 1.52-2.09), low HDL (yes versus no, OR=1.54, 95% CI: 1.28-1.86), high BUN (yes versus no, OR=1.58, 95% CI: 1.34-1.85), high creatinine (yes versus no, OR=3.09, 95% CI: 2.26-4.23), and high ALT levels (yes versus no, OR=1.36, 95% CI: 1.14-1.64) appeared to be significantly associated with hyperuricemia (Table 4). Data in Table 4 also indicate the considerably different results of multiple logistic regression analysis stratified by sex. Among males, significant risk factors for hyperuricemia included age (OR=1.02, 95% CI: 1.01-1.04), obesity (yes versus no, OR=1.53, 95% CI: 1.28-1.84), hypercholesterolemia (yes versus no, OR=1.26, 95% CI: 1.05-2.50), hypertriglyceridemia (OR=1.70, 95% CI: 1.38-2.08), low HDL (yes versus no, OR=1.52, 95% CI: 1.22-1.89), high BUN (yes versus no, OR=1.35, 95% CI: 1.10-1.65), and high creatinine levels (yes versus no, OR=3.75, 95% CI: 2.64-5.33). Among females, significant risk factors for hyperuricemia included age (OR=1.02, 95% CI: 1.00-1.04), obesity (yes versus no, OR=1.58, 95% CI: 1.23-2.03), type 2 diabetes (yes versus no, OR=1.54, 95% CI: 1.22-1.93), hypertriglyceridemia (OR=1.95, 95% CI: 1.52-2.51), low HDL (OR=1.65, 95% CI: 1.14-2.39), high BUN (OR=2.22, 95% CI: 1.69-2.92), and high ALT levels (OR=1.79, 95% CI: 1.31-2.43).
We next investigated whether age-related differences in hyperuricemia are associated with differences in the risk factors for hyperuricemia. Age-group disparities associated with hyperuricemia were also examined using the multiple logistic regression model. After adjustment for confounding factors, obesity and hypertension were the common factors associated with hyperuricemia (Table 5).
Hyperuricemia is considered to be the major etiological factor in gout. In addition to an inflammatory state triggered by urate crystal deposition in the joints, hyperuricemia has additional pathophysiological consequences causing tissue inflammation, mainly in the vascular wall.  Epidemiological studies have also demonstrated that high serum uric acid levels are associated with type 2 diabetes, hypertension, stroke, atherosclerosis, cardiovascular disease, and metabolic syndrome; a large-scale investigation indicated that elevated serum uric acid levels are associated with an increased mortality rate. [1,11-14] Hyperuricemia appears to increase the risk of coronary heart disease events in the general population, mainly adult females. 
Social problems resulting from the division between rich and poor have led to the coexistence of unsustainable lifestyles among approximately one billion people in the developed world and unacceptable poverty in another one billion people, largely from developing countries.  In this study, we used an age- and sex-based approach to estimate the morbidity of hyperuricemia in an elderly agricultural and fishing population. The prevalence of hyperuricemia in males and females was 30.2% and 30.6%, respectively. In multiple logistic regression analysis, age, obesity, type 2 diabetes, hypercholesterolemia, hypertriglyceridemia, low HDL level, and high BUN, creatinine, and ALT levels were independent predictors of hyperuricemia. A crucial benefit of a uric acid screening program is that gout and other chronic complications are often detected in apparently healthy individuals through elevated serum uric acid levels because the related screening tests are commonly included in serum chemistry panels.  The relative significance of these results is often overlooked when the serum uric acid levels are deemed slightly abnormal. In addition, the differences observed in factors associated with hyperuricemia in each age subgroup imply that multiple strategies for the health promotion of elderly people are necessary for reducing the risk of elevated serum uric acid levels.
Agriculture includes both crop and animal husbandry and fisheries to
produce the food requirements of humankind.  Good health and appropriate training programs are essential for agricultural and fishing professionals. Their long or irregular working hours may cause adverse health effects. To the best of our knowledge, however, few clinical evidence-based studies have determined the prevalence and possible etiology of hyperuricemia among the elderly agricultural and fishing population in Taiwan. The prevalence of hyperuricemia in various populations are presented in Table 6. The prevalence of hyperuricemia among different screened populations seems to vary between countries. [16-25] This disparity is likely due to differences among various populations with regard to participant characteristics (e.g., age, socioeconomic status, and abnormal associated factors), study period, and different diagnostic definitions for elevated serum uric acid levels. The prevalence of hyperuricemia in our study population (30.4%) was higher than that reported in previous population-based studies conducted in general Chinese populations. [11,16,20-22,25] The agricultural and fishing population endures strenuous working conditions, job stress, and reversed working and resting times compared to those of the general population.  Irregular lifestyles and carelessness regarding personal health are also major problems in this population. These factors might partially explain the apparently high prevalence of hyperuricemia observed in our study. Another reason for the discrepancy between the results for the general population and our results may be the differences in the populations studied.
Older age was a significant risk factor for hyperuricemia even in our elderly study population. This finding is consistent with the results of previous hospital- and community-based studies for general and occupational populations. [11,21-23] The mechanism underlying the slightly lower prevalence of hyperuricemia in males aged [greater than or equal to] 85 than in those aged 75-84 years remains unclear; nevertheless, in females, the increase in hyperuricemia prevalence with increasing age may be explained by postmenopausal changes in the endocrine system and estrogen levels. 
Consistent with other studies, [21,22,25] we observed a positive association between hyperuricemia and metabolic disorders in our Chinese population. Epidemiological studies have also reported an association between hyperuricemia and metabolic disorders such as metabolic syndrome, hyperlipidemia, obesity, and type 2 diabetes. [11,22,25] Metabolic syndrome is a cluster of three diseases-hypertension, hyperglycemia, and gout,  Although metabolic syndrome is clearly associated with obesity, insulin resistance, and abnormal blood lipids, which lead to the three diseases, the etiological mechanisms of this syndrome remain unknown.  Previous studies have indicated that serum uric acid level can be used as a crucial predictor of metabolic syndrome and that the number of metabolic syndrome components increases the prevalence and OR for significantly increased uric acid activity. [11,27,28]
Among patients with chronic hepatitis, fructose load may cause a substantial increase in serum uric acid levels. [5,7] Furthermore, serum uric acid levels are high in patients with chronic liver lesions. Our results regarding the significant association between high serum ALT level and hyperuricemia are similar to those reported in other studies. [5,29] However, because of the cross-sectional design of our study, we could not determine the extent to which the increase in serum ALT level occurs before hyperuricemia development.
Uric acid levels are high among renal failure patients because of decreased renal clearance.  A decrease in the glomerular filtration rate contributes to hyperuricemia, frequently observed in patients with chronic kidney disease.  Here, we observed a positive association between serum creatinine level and hyperuricemia, consistent with other studies. [11,31] Although evidence-based studies have indicated that serum uric acid itself may harm patients with chronic kidney disease by increasing inflammation and progression, the topic remains controversial.  In addition, we observed that BUN is strongly associated with hyperuricemia after adjustment for confounding factors. This suggests that BUN is an indicator of deterioration caused by hyperuricemia. A study indicated that despite significantly influencing serum uric acid, creatinine, and BUN levels, diuretic dose failed to emerge as the strongest predictor of serum uric acid in multiple regression analyses. This implied that increased diuretic dose may indirectly reflect the deterioration of renal function and clinical status. 
A major limitation of this study was potential selection bias because the screened elderly population was selected from only one area; this bias may have affected the estimated prevalence of and risk factors for hyperuricemia. Nevertheless, given our relatively large sample size, the statistical power was sufficient to effectively evaluate the presence of any sex differences between the various associated risk factors for hyperuricemia after adjusting for confounding factors. Second, we evaluated only elderly participants, who might have characteristics differing from those of the general population. This subpopulation is more susceptible to hyperuricemia than other populations in Taiwan. Third, some nonrespondents, who did not return for biochemical examination, may have had more prevalent hyperuricemia; thus, the prevalence may have been underestimated. Finally, our measurements were conducted at a single time point; hence, they cannot be used to reflect the effects of long-term exposure to the various risk factors, which may critically affect hyperuricemia. Thus, prospective longitudinal analogous studies are required, the results of which may complement the cross-sectional findings of this study.
In conclusion, in this study for prevalence of and risk factors for hyperuricemia in our elderly agricultural and fishing population, we noted several sex differences with regard to factors including age, obesity, type 2 diabetes, hypercholesterolemia, hypertriglyceridemia, low HDL level, and high BUN, creatinine, and ALT levels. Future studies are required to elucidate the temporal sequence of events typically leading to hyperuricemia and further explore the sex differences in the factors causing hyperuricemia among the elderly agricultural and fishing population.
Declaration of conflicting interests
The authors certify full disclosure of all affiliations or financial involvements with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in this manuscript, within the past five years and in the foreseeable future (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, and royalties).
The authors received no financial support for the research and/or authorship of this article.
[1.] Roozbeh J, Sagheb MM, Vafaie E. The association between blood pressure level and serum uric acid concentration in hemodialysis patients. J Nephropathol 2015; 4:85-90.
[2.] Smith EU, Diaz-Torne C, Perez-Ruiz F, March LM. Epidemiology of gout: an update. Best Pract Res Clin Rheumatol 2010; 24:811-27.
[3.] Luk AJ, Simkin PA. Epidemiology of hyperuricemia and gout. Am J Manag Care 2005; 11:435-42.
[4.] Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med 1987; 82:421-6.
[5.] Chen YF, Hu YC, Shen HC, Chang HT, Tung TH. Clinical implications in the prevalence and associated cardiovascular factors of elevated serum alanine aminotransferase levels among elderly agricultural and fishing population in Taipei, Taiwan: experience at a teaching hospital. J Investig Med 2014; 62:88-96.
[6.] Tung T, Chiu W, Lin T, Shih H, Hsu C. An exploration of prevalence and associated factors of nonalcoholic Fatty liver disease in the taiwanese police service. Iran J Public Health 2011; 40:54-62.
[7.] Liu CM, Tung TH, Chou P, Chen VT, Hsu CT, Chien WS, et al. Clinical correlation of gallstone disease in a Chinese population in Taiwan: experience at Cheng Hsin General Hospital. World J Gastroenterol 2006; 12:1281-6.
[8.] World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO Consultation. Part 1. Diagnosis and classification of diabetes mellitus. Geneva, World Health Organization, 1999
[9.] Cuddy ML. Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1). J Pract Nurs 2005; 55:17-21.
[10.] Gliozzi M, Malara N, Muscoli S, Mollace V. The treatment of hyperuricemia. Int J Cardiol 20165; 213:23-7.
[11.] Wei CY, Sun CC, Wei JC, Tai HC, Sun CA, Chung CF, et al. Association between Hyperuricemia and Metabolic Syndrome: An Epidemiological Study of a Labor Force Population in Taiwan. Biomed Res Int 2015; 2015:369179.
[12.] Guo M, Niu JY, Li SR, Ye XW, Fang H, Zhao YP, et al. Gender differences in the association between hyperuricemia and diabetic kidney disease in community elderly patients. J Diabetes Complications 2015; 29:1042-9.
[13.] Wang H, Jacobs DR Jr, Gaffo AL, Gross MD, Goff DC Jr, Carr JJ. Serum Urate and Incident Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. PLoS One 2015; 10:0138067.
[14.] Braga F, Pasqualetti S, Ferraro S, Panteghini M. Hyperuricemia as risk factor for coronary heart disease incidence and mortality in the general population: a systematic review and meta-analysis. Clin Chem Lab Med 2016; 54:7-15.
[15.] Kesavan PC, Swaminathan MS. Strategies and models for agricultural sustainability in developing Asian countries. Philos Trans R Soc Lond B Biol Sci 2008; 363:877-91.
[16.] Yu S, Yang H, Guo X, Zhang X, Zhou Y, Ou Q, et al. Prevalence of hyperuricemia and its correlates in rural Northeast Chinese population: from lifestyle risk factors to metabolic comorbidities. Clin Rheumatol 2016; 35:1207-15.
[17.] Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 2011; 63:3136-41.
[18.] You L, Liu A, Wuyun G, Wu H, Wang P. Prevalence of hyperuricemia and the relationship between serum uric acid and metabolic syndrome in the Asian Mongolian area. J Atheroscler Thromb 2014; 21:355-65.
[19.] Alikor CA, Emem-Chioma PC, Odia OJ. Prevalence of hyperuricaemia in a rural population of Nigerian Niger Delta region. Niger J Med 2013; 22:187-92.
[20.] Qu YL, Yu L, Li ZM, Kong LH, Xiao TC, Li M, et al. Epidemiological status and risk factors of hyperuricemia in rural area of the Three Gorges. Zhonghua Xin Xue Guan Bing Za Zhi 2013; 41:427-31.
[21.] Qiu L, Cheng XQ, Wu J, Liu JT, Xu T, Ding HT, et al. Prevalence of hyperuricemia and its related risk factors in healthy adults from Northern and Northeastern Chinese provinces. BMC Public Health 2013; 13:664. doi: 10.1186/1471-2458-13-664.
[22.] Yang J, Liu Z, Zhang C, Zhao Y, Sun S, Wang S, et al. The prevalence of hyperuricemia and its correlates in an inland Chinese adult population, urban and rural of Jinan. Rheumatol Int 2013; 33:1511-7.
[23.] Conen D, Wietlisbach V, Bovet P, Shamlaye C, Riesen W, Paccaud F, et al. Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country.BMC Public Health 2004; 4:9.
[24.] Nakamura K, Sakurai M, Miura K, Morikawa Y, Yoshita K, Ishizaki M, et al. Alcohol intake and the risk of hyperuricaemia: a 6-year prospective study in Japanese men. Nutr Metab Cardiovasc Dis 2012; 22:989-96.
[25.] Lin CS, Lee WL, Hung YJ, Lee DY, Chen KF, Chi WC, et al. Prevalence of hyperuricemia and its association with antihypertensive treatment in hypertensive patients in Taiwan. Int J Cardiol 2012; 156:41-6.
[26.] Yang YC, Chang CJ. Metabolic syndrome, obesity and diabetes. Formosan J of Med 2007; 2:370-80.
[27.] Corry DB, Eslami P, Yamamoto K, Nyby MD, Makino H, Tuck ML. Uric acid stimulates vascular smooth muscle cell proliferation and oxidative stress via the vascular renin-angiotensin system. J Hypertens 2008; 26:269-75.
[28.] Facchini F, Chen YD, Hollenbeck CB, Reaven GM. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA 1991; 266:3008-11.
[29.] Bruckert E, Giral P, Ratziu V, Poynard T, Chapman MJ, Opolon P, et al. A constellation of cardiovascular risk factors is associated with hepatic enzyme elevation in hyperlipidemic patients. Metabolism 2002; 51:1071-6.
[30.] Prasad Sah OS, Qing YX. Associations between hyperuricemia and chronic kidney disease: a review. Nephrourol Mon 2015; 7:27233.
[31.] Nakamura K, Sakurai M, Miura K, Morikawa Y, Yoshita K, Ishizaki M, et al. Alcohol intake and the risk of hyperuricaemia: a 6-year prospective study in Japanese men. Nutr Metab Cardiovasc Dis 2012; 22:989-96.
[32.] Tian Y, Chen Y, Deng B, Liu G, Ji ZG, Zhao QZ, et al. Serum uric acid as an index of impaired renal function in congestive heart failure. J Geriatr Cardiol 2012; 9:137-42.
Qian YU, (1,2) Hsi-che SHEN, (3,4) Yi-chun HU, (4) Yu-fen CHEN, (5) Tao-hsin TUNG (6,7)
(1) Department of Foot Science, Fu-Jen Catholic University, New Taipei City, Taiwan
(2) Department of Pharmacy, School of Biomedicine Sciences, Huaqiao University, Quanzhou, China
(3) Department of Healthcare Management, Yuanpei University, Hsinchu, Taiwan
(4) Department of Nursing, Taipei Medical University, Taipei, Taiwan
(5) Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
(6) Department of Medical Research and Education, Cheng-hsin General Hospital, Taipei, Taiwan
(7) Department of Public Health, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
Received: May 25, 2016
Accepted: July 31, 2016
Published online: April 13, 2017
Correspondence: Tao-hsin Tung, PhD. Department of Medical Research and Education, Cheng-hsin General Hospital, 112 Taipei, Taiwan.
Tel: 886228264400 e-mail: firstname.lastname@example.org
Table 1. Sex- and age-specific prevalence of hyperuricemia in study population Hyperuricemia Male (n=2,766) Screened Cases Prevalence p-value for No No % [chi square]-test for trend 65-74 1537 430 28.0 0.015 75-84 1033 343 33.2 >85 196 63 32.1 Total 2766 836 30.2 Hyperuricemia Female (n=l,606) Screened Cases Prevalence p-value for No No % [chi square]-test for trend 65-74 903 250 27.7 0.008 75-84 575 193 33.6 >85 128 49 38.3 Total 1606 492 30.6 Hyperuricemia Total (n=4,372) Screened Cases Prevalence p-value for No No % [chi square]-test for trend 65-74 2440 680 27.9 <0.0001 75-84 1608 536 33.3 >85 324 112 34.6 Total 4372 1328 30.4 Table 2. Hyperuricemia-related characteristics of study population Hyperuricemia All screened subjects No (n=3,044) Yes (n=l,328) Mean [+ or -] SD Mean [+ or -] SD Age (year) 73.0 [+ or -] 6.5 75.1 [+ or -] 6.7 BMI (kg/m=) 25.9 [+ or -] 5.3 28.0 [+ or -] 6.9 Fasting plasma qlucose (mq/dL) 99.5 [+ or -] 27.3 102.7 [+ or -] 28.6 SBP (mmHg) 136.9 [+ or -] 37.9 140.8 [+ or -] 33.2 DBP (mmHg) 78.8 [+ or -] 24.2 80.0 [+ or -] 17.7 Cholesterol (mg/dL) 199.6 [+ or -] 35.0 203.1 [+ or -] 37.2 Triqlyceride (mq/dL) 121.8 [+ or -] 80.6 153.1 [+ or -] 92.7 HDL (mg/dL) 55.8 [+ or -] 15.1 50.8 [+ or -] 14.3 BUN (mg/dL) 17.1 [+ or -] 4.7 19.2 [+ or -] 7.1 Creatinine (mg/dL) 0.9 [+ or -] 0.3 1.1 [+ or -] 0.6 ALT (U/L) 30.6 [+ or -] 21.1 33.2 [+ or -] 26.1 Hyperuricemia All screened subjects Total (n=4,372) p-value for t test Mean [+ or -] SD Age (year) 74.4 [+ or -] 6.6 <0.0001 BMI (kg/m=) 26.6 [+ or -] 5.8 <0..0001 Fasting plasma qlucose (mq/dL) 100.6 [+ or -] 27.8 0.007 SBP (mmHg) 138.2 [+ or -] 36.4 0.270 DBP (mmHg) 79.1 [+ or -] 22.3 0.744 Cholesterol (mg/dL) 200.7 [+ or -] 35.8 0.100 Triqlyceride (mq/dL) 132.1 [+ or -] 86.0 <0.0001 HDL (mg/dL) 54.1 [+ or -] 15.0 0.020 BUN (mg/dL) 17.8 [+ or -] 5.7 <0.0001 Creatinine (mg/dL) 1.0 [+ or -] 0.4 <0.0001 ALT (U/L) 31.5 [+ or -] 22.9 <0.0001 Hyperuricemia Males screened subjects No (n=l,930) Yes (n=836) Mean [+ or -] SD Mean [+ or -] SD Age (year) 73.1 [+ or -] 6.5 75.0 [+ or -] 6.8 BMI (kg/m=) 26.4 [+ or -] 6.7 28.7 [+ or -] 8.6 Fasting plasma qlucose (mq/dL) 99.8 [+ or -] 28.4 99.4 [+ or -] 24.9 SBP (mmHg) 136.5 [+ or -] 34.6 140.1 [+ or -] 38.0 DBP (mmHg) 78.5 [+ or -] 22.1 80.2 [+ or -] 20.2 Cholesterol (mg/dL) 194.1 [+ or -] 33.0 199.0 [+ or -] 34.6 Triqlyceride (mq/dL) 121.1 [+ or -] 89.0 148.3 [+ or -] 92.0 HDL (mg/dL) 53.3 [+ or -] 14.5 48.8 [+ or -] 13.8 BUN (mg/dL) 17.4 [+ or -] 4.8 19.2 [+ or -] 6.8 Creatinine (mg/dL) 1.0 [+ or -] 0.3 1.1 [+ or -] 0.5 ALT (U/L) 31.7 [+ or -] 24.0 33.6 [+ or -] 29.2 Hyperuricemia Males screened subjects Total (n=2,766) p-value for t test Mean [+ or -] SD Age (year) 74.4 [+ or -] 6.6 <0.0001 BMI (kg/m=) 27.2 [+ or -] 7.4 <0.0001 Fasting plasma qlucose (mq/dL) 99.6 [+ or -] 27.3 0.092 SBP (mmHg) 137.7 [+ or -] 35.8 0.278 DBP (mmHg) 79.1 [+ or -] 21.5 0.898 Cholesterol (mg/dL) 195.4 [+ or -] 33.6 0.186 Triqlyceride (mq/dL) 130.0 [+ or -] 90.9 0.001 HDL (mg/dL) 51.9 [+ or -] 14.4 0.045 BUN (mg/dL) 18.0 [+ or -] 5.6 <0.0001 Creatinine (mg/dL) 1.0 [+ or -] 0.4 <0.0001 ALT (U/L) 32.4 [+ or -] 25.8 0.029 Hyperuricemia Females screened subjects No (n=l,114) Yes (n=492) Mean [+ or -] SD Mean [+ or -] SD Age (year) 72.9 [+ or -] 6.6 75.3 [+ or -] 6.7 BMI (kg/m=) 25.1 [+ or -] 4.1 26.9 [+ or -] 4.1 Fasting plasma qlucose (mq/dL) 99.1 [+ or -] 25.3 108.3 [+ or -] 33.3 SBP (mmHg) 137.6 [+ or -] 43.0 142.0 [+ or -] 22.7 DBP (mmHg) 79.2 [+ or -] 27.5 79.6 [+ or -] 12.6 Cholesterol (mg/dL) 209.2 [+ or -] 36.3 2U.7 [+ or -] 39.8 Triqlyceride (mq/dL) 123.1 [+ or -] 63.7 161.2 [+ or -] 93.4 HDL (mg/dL) 60.0 [+ or -] 15.2 54.3 [+ or -] 14.5 BUN (mg/dL) 16.5 [+ or -] 4.5 19.2 [+ or -] 7.9 Creatinine (mg/dL) 0.8 [+ or -] 0.3 1.0 [+ or -] 0.7 ALT (U/L) 28.8 [+ or -] 14.7 32.3 [+ or -] 19.6 Hyperuricemia Females screened subjects Total (n=l,606) p-value for t test Mean [+ or -] SD Age (year) 74.4 [+ or -] 6.7 <0.0001 BMI (kg/m=) 25.7 [+ or -] 4.2 <0.0001 Fasting plasma qlucose (mq/dL) 102.1 [+ or -] 28.5 <0.0001 SBP (mmHg) 139.1 [+ or -] 37.6 0.632 DBP (mmHg) 79.4 [+ or -] 23.6 0.729 Cholesterol (mg/dL) 210.0 [+ or -] 34.5 0.264 Triqlyceride (mq/dL) 135.7 [+ or -] 76.9 <0.0001 HDL (mg/dL) 58.1 [+ or -] 15.2 0.245 BUN (mg/dL) 17.4 [+ or -] 6.0 <0.0001 Creatinine (mg/dL) 0.8 [+ or -] 0.5 <0.0001 ALT (U/L) 29.9 [+ or -] 16.5 <0.0001 SD: Standard deviation; BMI: Body mass index; SBP: Systolic blood pressure; DBP: diastolic blood pressure; HDL: High-density lipoprotein; BUN: Blood urea nitrogen; ALT: Alanine amino transferase. Table 3. Crude and adjusted odds ratios of hyperuricemia-related factors among study population Hyperuricemia Yes No (n=1,328) (n=3,044) Sex Female 492 1,114 Male 836 1,930 Age (year) 65-74 680 1,760 75-84 536 1,072 [greater than or 112 212 equal to] 85 Obesity No 672 2,002 Yes 656 1042 Type 2 diabetes No 1,143 1,901 Yes 623 705 Hypertension No 2,270 774 Yes 1049 279 Hypercholesterolemia No 664 1,634 Yes 664 1,401 Hypertriglyceridemia No 786 2,351 Yes 542 693 Low HDL No 983 2,619 Yes 345 425 High BUN No 906 2,437 Yes 422 607 High creatinine No 1,185 2,970 Yes 143 74 High ALT No 1,071 2,637 Yes 257 407 Crude OR (95% CI) P Sex Female 1.00 -- Male 0.98 (0.86-1.12) 0.78 Age (year) 65-74 1.00 -- 75-84 1.29 (1.10-1.47) 0.01 [greater than or 1.37 (1.19-2.27) <0.001 equal to] 85 Obesity No 1.00 -- Yes 1.88 (1.64-2.14) <0.001 Type 2 diabetes No 1.00 -- Yes 1.47 (1.29-1.67) <0.001 Hypertension No 1.00 -- Yes 1.28 (1.10-1.50) 0.002 Hypercholesterolemia No 1.00 -- Yes 1.17 (1.08-1.33) 0.016 Hypertriglyceridemia No 1.00 -- Yes 2.34 (2.04-2.69) <0.001 Low HDL No 1.00 -- Yes 2.16 (1.84-2.54) <0.001 High BUN No 1.00 -- Yes 1.87 (1.62-2.16) <0.001 High creatinine No 1.00 -- Yes 4.84 (3.63-6.46) <0.001 High ALT No 1.00 -- Yes 1.55 (1.31-1.85) <0.001 Adjusted OR * (95% CI) P Sex Female -- -- Male -- -- Age (year) 65-74 -- -- 75-84 -- -- [greater than or -- -- equal to] 85 Obesity No 1.00 -- Yes 1.53 (1.321.77) <0.001 Type 2 diabetes No 1.00 -- Yes 1.16 (1.01-133) 0.037 Hypertension No 1.00 -- Yes 1.13 (0.96-1.33) 0.143 Hypercholesterolemia No 1.00 -- Yes 1.22 (1.06-1.41) 0.005 Hypertriglyceridemia No 1.00 -- Yes 1.78 (1.52-2.09) <0.001 Low HDL No 1.00 -- Yes 1.54 (1.28-1.86) <0.001 High BUN No 1.00 -- Yes 1.57 (1.34-1.85) <0.001 High creatinine No 1.00 -- Yes 3.09 (2.26-4.23) <0.001 High ALT No 1.00 -- Yes 1.36 (1.14-1.64) 0.001 * Adjustment for sex and age; OR: Odds ratio; CI: Confidence interval; HDL: High-density lipoprotein; BUN: Blood urea nitrogen; ALT: Alanine amino transferase. Table 4. Multiple logistic regression of hyperuricemia-related factors among study population Hyperuricemia (yes versus no) Male Female OR 95% CI OR 95% CI Age (year) 1.02 1.01-1.04 1.02 1.00-1.04 Sex (female versus male) -- -- -- -- Obesity (yes versus no) 1.53 1.28-1.84 1.58 1.23-2.03 Type 2 diabetes 0.98 0.82-1.17 1.54 1.22-1.93 (yes versus no) Hypertension 1.09 0.89-1.34 1.20 0.91-1.57 (yes versus no) Hypercholesterolemia 1.26 1.05-2.50 1.20 0.95-1.53 (yes versus no) Hypertriglyceridemia 1.70 1.38-2.08 1.95 1.52-2.51 (yes versus no) Low HDL (yes versus no) 1.52 1.22-1.89 1.65 1.14-2.39 High BUN (yes versus no) 1.35 1.10-1.65 2.22 1.69-2.92 High creatinine 3.75 2.64-5.33 1.68 0.82-3.40 (yes versus no) High ALT 1.20 0.96-1.51 1.79 1.31-2.43 (yes versus no) Hyperuricemia (yes versus no) Total OR 95% CI Age (year) 1.02 1.01-1.03 Sex (female versus male) 0.83 0.72-1.27 Obesity (yes versus no) 1.53 1.32-1.77 Type 2 diabetes 1.16 1.01-1.33 (yes versus no) Hypertension 1.13 0.96-1.33 (yes versus no) Hypercholesterolemia 1.22 1.06-1.41 (yes versus no) Hypertriglyceridemia 1.78 1.52-2.09 (yes versus no) Low HDL (yes versus no) 1.54 1.28-1.86 High BUN (yes versus no) 1.58 1.34-1.85 High creatinine 3.09 2.26-4.23 (yes versus no) High ALT 1.36 1.14-1.64 (yes versus no) OR: Odds ratio; CI: Confidence interval; HDL: High-density lipoprotein; BUN: Blood urea nitrogen; ALT: Alanine amino transferase. Table 5. Multiple logistic regression of hyperuricemia-related factors for stratified by age group 65-74 years 75-84 years (n=2,456) (n=1,613) OR 95% CI OR 95% CI Sex (male versus female) 0.80 0.65-0.98 0.92 0.72-1.16 Obesity (yes versus no) 1.57 1.29-1.92 1.42 1.13-1.79 Type 2 diabetes 1.17 0.96-1.42 1.20 0.96-1.50 (yes versus no) Hypertension 1.24 0.99-1.55 0.93 0.71-1.21 (yes versus no) Hypercholesterolemia 1.04 0.85-1.26 1.43 1.14-1.85 (yes versus no) Hypertriglyceridemia 1.99 1.61-2.46 1.58 1.21-2.05 (yes versus no) Low HDL (yes versus no) 1.36 1.05-1.76 1.70 1.26-2.28 High BUN (yes versus no) 1.47 1.16-1.86 1.66 1.29-2.12 High creatinine 2.66 1.56-4.54 2.83 1.83-4.38 (yes versus no) High ALT (yes versus no) 1.55 1.23-1.96 1.18 0.86-1.61 [greater than or equal to] 85 years (n=326) OR 95% CI Sex (male versus female) 0.61 0.35-1.07 Obesity (yes versus no) 1.83 1.03-3.24 Type 2 diabetes 0.85 0.49-1.48 (yes versus no) Hypertension 1.52 0.79-2.95 (yes versus no) Hypercholesterolemia 1.91 1.10-3.30 (yes versus no) Hypertriglyceridemia 1.66 0.86-3.21 (yes versus no) Low HDL (yes versus no) 2.41 1.20-4.83 High BUN (yes versus no) 1.93 1.11-3.33 High creatinine 7.72 3.05-19.57 (yes versus no) High ALT (yes versus no) 0.45 0.15-1.31 OR: Odds ratio; CI: Confidence interval; HDL: High-density lipoprotein; BUN: Blood urea nitrogen; ALT: Alanine amino transferase. Table 6. Prevalence of hyperuricemia among various populations Author Study year Screened Setting number Yu et 2012 11,576 Northeast China al.  Zhu et 2007 5,707 United States al.  You et 2009 1,426 Mongolia al.  Alikor et 2013 500 Nigeria al.  Qu et 2007 9,354 Three Gorges, al.  China Qiu et 2008 13,141 Northern China al.  Yang et 2012 4,218 Jinan, China al.  Conen et 2004 1,011 The Seychelles, al.  Indian Ocean, population mainly of African origin Nakamura et 2011 3,310 Japan al.  Lin et 2010 2,145 Taiwan al.  Author Prevalence of Associated factors hyperuricemia (%) Yu et Overall: 10.9 Abdominal obesity, al.  Male: 15.0 general obesity, Female: 7.3 hypertriglyceridemia, hypertension, hypercholesterolemia, low HDL-C, ethnic minority, physical activity, current smoking, drinking Zhu et Overall: 3.9 Adiposity, al.  Male: 5.9 hypertension Female: 2.0 You et Male: 17.7 Waist circumference, al.  Female: 5.2 the level of triglycerides Alikor et Overall: 17.2 Waist circumference, al.  Male: 25 total cholesterol, Female: 13.7 LDL, sex Qu et Male: 5.6 Alcohol drinking, al.  Female: 3.3 low intake of green vegetables and fruits Qiu et Overall: 13.7 Age, sex, residence, al.  Male: 21 obesity Female: 7.9 hypertension, abdominal obesity impaired fasting glucose, CKD, drinking and sleeping, hypercholesterolemia, hypertriglyceridemia, Yang et Male: 6.4 Male sex, urban al.  Female: 2.1 residence, obesity, Urban: 6.7% hypertension, high Rural areas: 1.7% serum creatinine level, hyper triglyceridemia, hypercholeste rolemia, Conen et Male: 35.2 Serum triglycerides, al.  Female: 8.7 age, BMI, blood pressure, alcohol, the use of antihypertensive therapy Nakamura et 21.6 Habitual alcohol al.  intake Lin et Given thiazides: 44% Given Impaired renal al.  loop diuretics: 56% Given function, diuretic aldosterone receptor use blockers: 57% HDL-C: High-density lipoprotein C; LDL: Low density lipoprotein; CKD: Chronic kidney disease; BMI: Body mass index.
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Yu, Qian; Shen, Hsi-che; Hu, Yi-chun; Chen, Yu-fen; Tung, Tao-hsin|
|Publication:||Turkish Journal of Rheumatology|
|Date:||Jun 1, 2017|
|Previous Article:||Survival analysis of Turkish patients with systemic lupus erythematosus: older age at diagnosis affects mortality.|
|Next Article:||Rectal adenocarcinoma as an uncommon cause of immunoglobulin a vasculitis (henoch-schonlein purpura).|