Abstract
Abstract: There is a conflict in the literature regarding the association between serum uric acid (SUA) levels and glycemic status. Therefore, we evaluated the association between SUA level and glycemic status - impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes mellitus - and insulin resistance, in a large Brazilian study. This is a cross-sectional, observational study with 13,207 participants aged 35-74 years, at baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A multinomial regression analysis was performed to test the association between SUA and glycemic status (IFG, IGT, and newly diagnosed type 2 diabetes at the cohort baseline) after adjustments by age, sex, skin color, body mass index, physical activity, smoking, alcohol consumption, comorbidities, and medicines use. Logistic regression model was used to evaluate the association between SUA and insulin resistance by HOMA-IR. Stratified analyses by sex were performed. The mean age (standard deviation) was 51.4 (8.9) years, 55.2% of participants were women. There were 1,439 newly diagnosed diabetes. After all adjustments, higher SUA was associated with IFG, IGT, and diabetes, with odds ratio (OR) = 1.15 (95%CI: 1.06; 1.25), 1.23 (95%CI: 1.14; 1.33), and 1.37 (95%CI: 1.24; 1.51), respectively. There was association between SUA levels and insulin resistance with OR = 1.24 (95%CI: 1.13; 1.36). In analysis stratified by sex, higher SUA persisted independently associated with impaired glycemic status. Our results suggest that a higher SUA levels were significantly associated with glycemic status in a large Latin American population, mainly among women.
Highlights
Diabetes mellitus is a public health problem
This study investigated the association between glycemic status and serum uric acid (SUA) levels in men and women at the baseline of a large cohort of Brazilian adults
After adjusting for demographic, anthropometric, health conditions, laboratory variables, and for the intake of some food groups, alcoholic beverages, and use of medicines, it was observed that higher SUA levels were independently associated with abnormal glycemic status and insulin resistance
Summary
Being a highly prevalent condition that increases cardiovascular risk and associated morbimortality, diabetes is associated with high health expenditures and large economic impact on health systems 1. About 463 million adults were diagnosed with diabetes worldwide by 2019 2. Higher serum uric acid (SUA) levels are associated with the development of gout, cardiovascular diseases, renal disease, and inflammatory process 3. The association between elevated SUA levels and increased risk of hyperglycemia has been reported by some authors [4,5,6,7,8]. A meta-analysis showed that elevation of 1mg/dL in the SUA level was associated with a 17% risk increase of developing diabetes. Other studies, including some with genetic evaluation, have not shown positive association between higher uricemia and hyperglycemia [9,10,11]. Studies have found that urate is involved in oxidative stress, systemic inflammation, insulin sensibility, and intrahepatic fructose metabolism 12
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