Original Article
Metabolically healthy obesity also has risk for hyperuricemia among Chinese general population: A cross-sectional study

https://doi.org/10.1016/j.orcp.2016.03.008Get rights and content

Summary

Introduction

The metabolically healthy obese (MHO) refers to obese individuals with a favorable metabolic profile. It is unknown whether metabolically healthy status in persons with obesity or overweight decreases the risk of hyperuricemia. This study aims to explore the association of MHO with risk of hyperuricemia.

Methods

We performed a cross-sectional study including 11,435 (5300 men and 6135 women) general population aged ≥35 years in Liaoning Province. Anthropometric measurements, laboratory examinations and self-reported information on lifestyle factors were collected by trained personnel. Metabolically healthy overweight/obesity was defined according to body mass index and ATP-III criterion of metabolically healthy status. Hyperuricemia was defined as SUA ≥7 mg/dl (420 mmol/L) in men or ≥6 mg/dl (360 mmol/L) in women. Logistic regression analyses were performed to explore the association between overweight/obesity with different metabolic status and risk of hyperuricemia.

Results

Among total subjects, 470 (4.2%) were metabolically healthy obese (MHO) and 1567 (14.0%) were metabolically unhealthy obese (MUO). For metabolically healthy female participants, the prevalence of hyperuricemia with overweight was similar to with a normal BMI (2.5% vs. 3.1%, P = 0.314). Multivariate logistic regression analyses showed that MHO (OR = 2.48, 95% CI: 1.81–3.41) and MUO (OR = 4.81, 95% CI: 3.97–5.83) were significantly associated with hyperuricemia. However, the odds ratio in females with metabolically healthy overweight was 0.85 (95% CI: 0.53–1.37).

Conclusions

Metabolically healthy might decline the risk of hyperuricemia, but overweight and obesity with metabolically healthy had also strong associations with hyperuricemia, except in females with metabolically healthy overweight.

Introduction

In recent decades, obesity has become a major public health and social problem worldwide [1]. Obesity is acknowledged to be one of the independent risk factors for both cardiovascular disease (CVD) and type 2 diabetes mellitus (DM) [2], [3], and is often accompanied by hyperuricemia [4]. Meanwhile, hyperuricemia is commonly detected in subjects with abnormal purine metabolism, including overproduction of uric acid (UA) and insufficient UA excretion from the kidneys [5]. Prolonged hyperuricemia is a causal factor in the development of damage to joints, connective tissues, and the kidneys. Hyperuricemia is related not only to an increased risk of developing gout, but also cardiovascular diseases, such as stroke and ischemic heart disease. Obesity is a known determinant of serum uric acid (SUA) levels, and obesity and SUA levels correlate positively regardless of age or sex [6]. Furthermore, SUA levels also decrease with weight loss [7].

Recently, researchers have proposed a novel concept that within populations with obesity a subgroup exists which presents no metabolic disturbances, termed metabolically healthy obese (MHO). A current debate has arisen from the multiple studies which suggest that MHO individuals might be at lower risk of suffering cardiovascular events and all-cause mortality [8]. Some researchers consider that obesity is no longer a risk factor for CVD and all-cause mortality if accompanied by a healthy metabolism [8], [9], [10]. Thus, not all individuals with obesity should be included into treatment programs, which could help to reduce the medical and socioeconomic burdens associated with obesity treatment [8]. However, other prospective cohort studies and systematic reviews [11], [12] conclude that MHO individuals are not at a lower risk of CVD incidence and all-cause mortality [12], and argue that MHO is not a relatively healthy status.

At present, no consistent conclusion has been reached regarding the benefits of MHO status. It has been shown that both obesity and metabolism have a close relationship with hyperuricemia [13], [14]. However, it is yet to be established whether the new subgroup within obese/overweight, populations of metabolically healthy obese/overweight individuals could have a decreased the risk level of hyperuricemia. This study aims to explore the association of MHO phenotype with risk of hyperuricemia in a representative general sample of adults living in the rural areas of the Liaoning Province, China.

Section snippets

Study population

From July 2012 to August 2013, we selected a representative general sample aged ≥35 years to describe the prevalence, incidence and natural history of cardiovascular risk factors in rural areas of Liaoning Province that is located in Northeast China. The study adopted a multi-stage, stratified randomly cluster-sampling scheme. In the first stage, 3 counties (Dawa, Zhangwu, and Liaoyang County) were selected from the eastern, southern, and northern region of Liaoning Province. In the second

Results

Table 1 presents the baseline characteristics of the participants according to BMI and metabolic status. After removing 263 samples (BMI < 18.5 kg/m2), 11,172 participants remained, comprising 5209 males (46.6%) and 5963 females (53.4%). Based on the categories of BMI and metabolic status, 3874 (34.7%) subjects had a normal BMI with a healthy metabolism, 470 (4.2%) were metabolically healthy obese (MHO) and 1567 (14.0%) were metabolically unhealthy obese (MUO). Among the MHO participants, 221

Discussion

As reported in the Framingham study [22], patients with gout have significantly greater BMI scores. In addition, SUA concentration is closely linked with metabolic syndrome [23], and having a metabolically healthy status likewise decreases the risk of hyperuricemia. Some researchers even proposed that uric acid may be an underdiagnosed mediator of adverse outcomes in individuals with metabolically healthy overweight/obese [24]. However, metabolically healthy subgroups of individuals with

Conflict of interest

All the authors have not any conflicts of interest. All authors read and approved the final manuscript.

Author contribution

YS and LZ designed research; LZ, SY, and HY conducted research and acquired the data; YC analyzed data; YC wrote the article; NJ, GZ, and XG critically revised the manuscript for important intellectual content; YC and YS had primary responsibility for final content.

Acknowledgements

This study was supported by grants from the “Twelfth Five-Year” project funds (National Science and Technology Support Program of China, Grant #2012BAJ18B02) that Pro Yingxian Sun responsible for enable the project completion.

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