EMİN MURAT AKBAŞ, ADALET ÖZÇİÇEK, FATİH ÖZÇİÇEK, LEVENT DEMİRTAŞ, AYSU TİMUROĞLU, Adem GÜNGÖR, Nergis AKBAŞ

Metabolik olarak sağlıklı ve sağlıksız obez hastalarda ürik asit seviyeleri

Amaç: Çalışmamızda, metabolik olarak sağlıklı ve sağlıksız obez bireyler arasında serum ürik asit seviyelerindeki farkların araştırılması amaçlanmıştır. Yöntemler: Çalışmamızda; hastanemiz iç hastalıkları ve endokrinoloji polikliniklerine kilo fazlalığı şikayeti ile baş- vuran hastalarda, metabolik sendrom tanı kriterleri araş- tırılarak, metabolik olarak sağlıklı obezler ve sağlıksız obezler olarak iki grup oluşturuldu. Çalışmaya yaşları 18 ile 70 arasında değişen, toplam 193 kadın katılımcı alındı. Bulgular: Metabolik olarak sağlıklı obezler ve metabolik olarak sağlıksız obezler arasında bel çevresi (p=0,038), HOMA-IR (p0,05). Hastalar ürik asit median değerine göre iki gruba ayrıldığında, ürik asit yüksek grupta, metabolik sendrom rastlanma oranının arttığı tespit edildi (p=0,021). Metabolik sendrom ile ilişkisinin yanında, ürik asidin, korelasyon analizinde, metabolik sendrom kriterlerinin sayı- sı ile de anlamlı ilişki tespit edildi (r=0,270, p

Uric acid levels in metabolically healthy and unhealthy obese patients

Objective: In this study, we aimed to investigate the difference of uric acid levels between metabolically healthy and unhealthy obese individuals. Methods: Patients of internal medicine and endocrinology outpatient clinics who admitted with the complaint of overweight were separated into two groups, by diagnostic criteria for metabolic syndrome, as metabolically healthy obese and metabolically unhealthy obese individuals. Total of 193 women aged between 18 to 70 years were enrolled into study. Results: Statistically significant differences were determined regarding waist circumference (p=0.038), HOMAIR (p<0.001) and uric acid levels (p=0.001) between metabolically healthy obese and metabolically unhealthy obese patients while high-sensitive CRP levels (p>0.05) were not differ between these groups. When patients were separated into two groups according to uric acid median, the rate of metabolic syndrome found to be increased in high uric acid group (p=0.021). A correlation analysis showed that uric acid was significantly associated with number of metabolic syndrome parameters (r=0.270, p<0.001) beyond presence of metabolic syndrome. Conclusion: In the fact of determined relation of uric acid with the insulin resistance and significant difference of uric acid levels between metabolically healthy and nonhealthy obese groups, uric acid can be considered as a cheap, accessible and sensitive parameter for metabolic syndrome and cardiovascular risk factor in obese individuals.

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1. Karelis AD. Metabolically healthy but obese individuals. Lancet 2008;372:1281-1283.
2. Yoo HK, Choi EY, Park EW, et al. Comparison of metabolic characteristics of metabolically healthy but obese (mho) middle-aged men according to different criteria. Korean J Fam Med 2013;34:19-26.
3. Ciarla S, Struglia M, Giorgini P, et al. Serum uric acid levels and metabolic syndrome. Arch Physiol Biochem 2014;120:119-122.
4. Li Y, Chen S, Shao X, et al. Association of uric acid with metabolic syndrome in men, premenopausal women and postmenopausal women. Int J Environ Res Public Health 2014;11:2899-2910.
5. Ndrepepa G, Braun S, King L, et al. Uric acid and prognosis in angiography-proven coronary artery disease. Eur J Clin Invest 2013;43:256-266.
6. Deveci O, Kabakci G, Okutucu S, et al. The association between serum uric acid level and coronary artery disease. Int J Clin Pract 2010;64:900-907.
7. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-419.
8. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-2752.
9. Bhurosy T, Jeewon R. Overweight and obesity epidemic in developing countries: A problem with diet, physical activity, or socioeconomic status? Sci World J 2014;2014: 964236.
10. Primeau V, Coderre L, Karelis AD, et al. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes (Lond) 2011; 35: 971-981.
11. Taksali SE, Caprio S, Dziura J, et al. High visceral and low abdominal subcutaneous fat stores in the obese adolescent: a determinant of an adverse metabolic phenotype. Diabetes 2008;57:367-371.
12. Pajunen P, Kotronen A, Korpi-Hyovalti E, et al. Metabolically healthy and unhealthy obesity phenotypes in the general population: the FIN-D2D Survey. BMC Public Health 2011;11:754.
13. Shiina Y, Homma Y. Relationships between the visceral fat area on CT and coronary risk factor markers. Intern Med 2013; 52: 1775-1780.
14. Roriz AK, Mello AL, Guimaraes JF, et al. Imaging assessment of visceral adipose tissue area and its correlations with metabolic alterations. Arq Bras Cardiol 2010;95:698-704.
15. Bedir A, Topbas M, Tanyeri F, et al. Leptin might be a regulator of serum uric acid concentrations in humans. Jpn Heart J 2003;44:527-536.
16. Choi HK, Mount DB, Reginato AM, American College of P and American Physiological S. Pathogenesis of gout. Ann Intern Med 2005;143:499-516.
17. Dessein PH, Shipton EA, Stanwix AE, Joffe BI, Ramokgadi J. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000;59:539-543.
18. Facchini F, Chen YD, Hollenbeck CB and Reaven GM. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA 1991;266:3008-3011.
19. Heinig M, Johnson RJ. Role of uric acid in hypertension, renal disease, and metabolic syndrome. Cleve Clin J Med 2006; 73: 1059-1064.
20. Muscelli E, Natali A, Bianchi S, et al. Effect of insulin on renal sodium and uric acid handling in essential hypertension. Am J Hypertens 1996;9:746-752.
21. Ter Maaten JC, Voorburg A, Heine RJ, et al. Renal handling of urate and sodium during acute physiological hyperinsulinaemia in healthy subjects. Clin Sci (Lond) 1997;92:51- 58.
22. Nakamura K, Sakurai M, Miura K, et al. HOMA-IR and the risk of hyperuricemia: A prospective study in non-diabetic Japanese men. Diabetes Res Clin Pract 2014;106:154-160.
23. Tinahones FJ, Soriguer FJ, Collantes E, Perez-Lindon G, Sanchez Guijo P and Lillo JA. Decreased triglyceride levels with low calorie diet and increased renal excretion of uric acid in hyperuricaemic-hyperlipidaemic patients. Ann Rheum Dis 1995;54:609-610.
24. Li LJ, Chen H, Ren JY, Wang L and Luo Y. [Effects of micronized fenofibrate on lipid and uric acid metabolism in patients with hyperlipidemia]. Beijing Da Xue Xue Bao 2009;41:541-544.
25. Conen D, Wietlisbach V, Bovet P, 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.
26. Adiels M, Olofsson SO, Taskinen MR, Boren J. Overproduction of very low-density lipoproteins is the hallmark of the dyslipidemia in the metabolic syndrome. Arterioscler Thromb Vasc Biol 2008;28:1225-1236.
27. Zhu Y, Hu Y, Huang T, et al. High uric acid directly inhibits insulin signalling and induces insulin resistance. Biochem Biophys Res Commun 2014;447:707-714.
28. Mangge H, Zelzer S, Puerstner P, et al. Uric acid best predicts metabolically unhealthy obesity with increased cardiovascular risk in youth and adults. Obesity (Silver Spring) 2013;21:E71-77.
29. de Ferranti SD, Rifai N. C-reactive protein: a nontraditional serum marker of cardiovascular risk. Cardiovasc Pathol 2007; 16: 14-21.
30. Kannel WB. Overview of hemostatic factors involved in atherosclerotic cardiovascular disease. Lipids 2005; 40: 1215-1220.
31. Ridker PM. C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol 2007;49:2129-2138.
32. Rifai N, Ridker PM. High-sensitivity C-reactive protein: a novel and promising marker of coronary heart disease. Clin Chem 2001;47:403-411.