Relationship between Metabolic Syndrome and Uric Acid to Creatinine Ratio in Korean Adults: Korea National Health and Nutrition Examination Survey 2016

Sae-Ron Shin; A Lum Han

doi:10.15384/kjhp.2018.18.3.113

Korean J Health Promot > Volume 18(3); 2018 > Article

Shin and Han: Relationship between Metabolic Syndrome and Uric Acid to Creatinine Ratio in Korean Adults: Korea National Health and Nutrition Examination Survey 2016

Original Article

Korean Journal of Health Promotion 2018;18(3):113-118.

Published online: January 10, 2018

DOI: https://doi.org/10.15384/kjhp.2018.18.3.113

Relationship between Metabolic Syndrome and Uric Acid to Creatinine Ratio in Korean Adults: Korea National Health and Nutrition Examination Survey 2016

Sae-Ron Shin, A Lum Han

Department of Family Medicine, Wonkwang University Hospital, Iksan, Korea

￭ Corresponding author: A Lum Han, MD, PhD Department of Family Medicine, Wonkwang University Hospital, 501 Iksan-daero, Iksan 54536, Korea
Tel: +82-63-859-1300, Fax: +82-63-859-1306 E-mail: qibosarang@naver.com

Received August 02, 2018 Accepted September 25, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

While the correlation between metabolic syndrome (MS) and serum uric acid (sUA) levels has already been identified, the correlation between MS and the sUA/creatinine ratio has not been studied in Korea. Accordingly, the present study examined the correlation between MS and the sUA/creatinine ratio using data from the seventh Korea National Health and Nutrition Examination Survey (2016).

Methods

The study population consisted of healthy adults aged 19 years or older medical diseases. The five components of MS and the presence of MS were used as independent variables, while the sUA/creatinine ratio was selected as the dependent variable. After adjusting for confounding variables, a complex samples logistic regression test was performed to analyze the correlations between the sUA/creatinine ratio and MS and its components.

Results

The following variables showed positive correlation with the sUA/creatinine ratio: systolic blood pressure (BP) (95% confidence interval [CI], 1.051–1.243; P=0.002), diastolic BP 1.144 (95% CI, 1.054–1.241; P=0.001), fasting blood sugar level 1.166 (95% CI, 1.070–1.271; P<0.001), triglyceride level 1.340 (95% CI, 1.259–1.427; P<0.001), high density lipoprotein level 1.163 (95% CI, 1.100–1.230; P<0.001), waist circumference 1.342 (95% CI, 1.239–1.455; P<0.001), and the presence of MS 1.041 (95% CI, 1.034–1.049; P≤0.001).

Conclusions

The findings of the present study demonstrated a statistically significant correlation between the sUA/creatinine ratio and the presence of MS as well as with each component of MS. The significance of the present study is that it is the first study to investigate Koreans.

Keywords: Metabolic syndrome, Uric acid, Creatinine

Table 1.

Comparison of non-metabolic syndrome group and metabolic syndrome group in study participants

	Non-MetS group n=2,840 (81.2)	MetS group n=672 (18.8)	P^a
Age, y	39.14±0.32	46.03±0.66	<0.001
Sex
Male	10,292,158.23/1,151 (47.8)	3,478,776.98/409 (69.6)	<0.001
Female	11,239,099.82/1,689 (52.2)	15,204,153.37/263 (30.4)
Smoking status
No	16,469,069.35/2,275 (77.4)	3,103,038.44/452 (63.5)	<0.001
Yes	4,812,785.44/534 (22.6)	1,783,042.32/207 (36.5)
Alcohol drinking frequency
No	2,155,041.26/345 (10.8)	711,948.84/100 (15.7)
<1/month	3,854,068.97/538 (19.3)	648,940.35/99 (14.3)
=1/month	2,714,161.67/328 (13.6)	361,983.11/52 (8.0)	<0.001
2–4/month	6,471,337.08/777 (32.4)	1,202,023.85/151 (26.5)
2–3/week	3,504,747.82/448 (17.5)	1,086,540.20/129 (24.0)
>4/week	1,290,625.48/165 (6.5)	524,116.48/70 (11.6)
Systolic blood pressure (mmHg)	112.54±0.32	126.45±0.63	<0.001
Diastolic blood pressure (mmHg)	74.02±0.22	84.41±0.42	<0.001
Fasting blood glucose (mg/dL)	92.60±0.41	108.61±1.09	<0.001
HbA1c (%)	5.37±0.01	5.78±0.03	<0.001
Total cholesterol (mg/dL)	192.75±0.80	210.98±1.82	<0.001
HDL cholesterol (mg/dL)	54.69±0.28	41.65±0.41	<0.001
Triglyceride (mg/dL)	109.03±1.87	260.00±12.89	<0.001
LDL cholesterol (mg/dL)	123.09±2.83	123.15±2.10	0.986
Waist circumference (cm)	78.98±0.21	91.10±0.37	<0.001
BMI (kg/m²)	22.87±0.07	26.77±0.16	<0.001
hsCRP	0.087±0.02	1.48±0.07	<0.001
Serum UA (mg/dL)	4.96±0.02	5.85±0.06	<0.001
Serum Cr (mg/dL)	0.82±0.00	0.88±0.00	<0.001
Serum UA/Cr	6.15±0.03	6.71±0.07	<0.001

Abbreviations: MetS, metabolic syndrome; HbA1c, hemoglobin A1c; HDL, high density lipoprotein; LDL, low density lipoprotein; BMI, body mass index; hsCRP, highly sensitive C-reactive protein; UA, uric acid; Cr, creatinine.

Values are presented as mean±standard error or unweighted number/weighted number (weighted %). Percentages were weighted using the Korean National Health and Nutrtion Examination Survey 2016 sampling weights.

^a P-value was taken by complex sample Rao-Scott adjusted chi-square test or complex sample generalized linear model t-test.

Table 2.

Crude odds ratios for MetS and components by serum uric acid to creatinine ratio

Variable	Serum UA/Cr
Variable	Odds ratio	P^a	95% confidence interval
Systolic blood pressure (mmHg)
<130	Reference
≥130	1.083	0.027	1.009–1.162
Diastolic blood pressure (mmHg)
<85	Reference
≥85	1.117	0.002	1.041–1.198
Fasting blood glucose (mg/dL)
<100	Reference
≥100	1.109	0.004	1.034–1.189
Serum triglyceride (mg/dL)
<150	Reference
≥150	1.293	<0.001	1.223–1.367
HDL Cholesterol (mg/dL)
Man ≥50, woman ≥45	Reference
Man <50, woman <45	1.128	<0.001	1.071–1.189
Waist circumference (cm)
Man <90, woman <85	Reference
Man ≥90, woman ≥85	1.311	<0.001	1.216–1.414
Metabolic syndrome
No	Reference
Yes	1.284	<0.001	1.177–1.400

Abbreviations: MetS, metabolic syndrome; UA, uric acid; Cr, creatinine; HDL, high density lipoprotein.

^a P-value was taken by complex samples logistic regression test.

Table 3.

Adjusted odds ratios for MetS and components by serum uric acid to creatinine ratio

Variable	Serum UA/Cr
Variable	Odds ratio	P^a	95% confidence interval
Systolic blood pressure (mmHg)
<130	Reference
≥130	1.143	0.002	1.051–1.243
Diastolic blood pressure (mmHg)
<85	Reference
≥85	1.144	0.001	1.054–1.241
Fasting blood glucose (mg/dL)
<100	Reference
≥100	1.166	<0.001	1.070–1.271
Serum triglyceride (mg/dL)
<150	Reference
≥150	1.340	<0.001	1.259–1.427
Low HDL cholesterol (mg/dL)
Man ≥50, woman ≥45	Reference
Man <50, woman <45	1.163	<0.001	1.100–1.230
Waist circumference (cm)
Man <90, woman <85	Reference
Man ≥90, woman ≥85	1.342	<0.001	1.239–1.455
Metabolic syndrome
No	Reference
Yes	1.041	<0.001	1.034–1.049

Abbreviations: MetS, metabolic syndrome; UA, uric acid; Cr, creatinine; HDL, high density lipoprotein. Adjust for age, sex and smoking status, alcohol drinking frequency, exercise frequency.

^a P-value was taken by complex samples logistic regression test.

References

1. Park E, Kim J. Gender- and age-specific prevalence of metabolic syndrome among Korean adults: analysis of the fifth Korean National Health and Nutrition Examination Survey. J Cardiovasc Nurs 2015;30(3):256-66.

2. Quiñones Galvan A, Natali A, Baldi S, Frascerra S, Sanna G, Ciociaro D, et al. Effect of insulin on uric acid excretion in humans. Am J Physiol 1995;268(1 Pt 1):E1-5.

3. Nakagawa T, Hu H, Zharikov S, Tuttle KR, Short RA, Glushakova O, et al. A causal role for uric acid in fructose-induced metabolic syndrome. Am J Physiol Renal Physiol 2006;290(3):F625-31.

4. Gagliardi AC, Miname MH, Santos RD. Uric acid: a marker of increased cardiovascular risk. Atherosclerosis 2009;202(1):11-7.

5. Fu CC, Wu DA, Wang JH, Yang WC, Tseng CH. Association of C-reactive protein and hyperuricemia with diabetic nephropathy in Chinese type 2 diabetic patients. Acta Diabetol 2009;46(2):127-34.

6. Guo L, Cheng Y, Wang X, Pan Q, Li H, Zhang L, et al. Association between microalbuminuria and cardiovascular disease in type 2 diabetes mellitus of the Beijing Han nationality. Acta Diabetol 2012;49(Suppl 1):S65-71.

7. Ruggiero C, Cherubini A, Ble A, Bos AJ, Maggio M, Dixit VD, et al. Uric acid and inflammatory markers. Eur Heart J 2006;27(10):1174-81.

8. Chen N, Wang W, Huang Y, Shen P, Pei D, Yu H, et al. Community-based study on CKD subjects and the associated risk factors. Nephrol Dial Transplant 2009;24(7):2117-23.

9. Coresh J, Wei GL, McQuillan G, Brancati FL, Levey AS, Jones C, et al. Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med 2001;161(9):1207-16.

10. Muntner P, He J, Hamm L, Loria C, Whelton PK. Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 2002;13(3):745-53.

11. Gu L, Huang L, Wu H, Lou Q, Bian R. Serum uric acid to creatinine ratio: a predictor of incident chronic kidney disease in type 2 diabetes mellitus patients with preserved kidney function. Diab Vasc Dis Res 2017;14(3):221-5.

12. Durmus Kocak N, Sasak G, Aka Akturk U, Akgun M, Boga S, Sengul A, et al. Serum uric acid levels and uric acid/creatinine ratios in stable chronic obstructive pulmonary disease (COPD) patients: are these parameters efficient predictors of patients at risk for exacerbation and/or severity of disease? Med Sci Monit 2016;22:4169-76.

13. Al-Daghri NM, Al-Attas OS, Wani K, Sabico S, Alokail MS. Serum uric acid to creatinine ratio and risk of metabolic syndrome in Saudi type 2 diabetic patients. Sci Rep 2017;7(1):12104.

14. Li M, Gu L, Yang J, Lou Q. Serum uric acid to creatinine ratio correlates with β-cell function in type 2 diabetes. Diabetes Metab Res Rev 2018;34(5):e3001.

15. Santos RD. Elevated uric acid, the metabolic syndrome and cardiovascular disease: cause, consequence, or just a not so innocent bystander? Endocrine 2012;41(3):350-2.

16. Johnson RJ, Titte S, Cade JR, Rideout BA, Oliver WJ. Uric acid, evolution and primitive cultures. Semin Nephrol 2005;25(1):3-8.

17. Reaven G. Why a cluster is truly a cluster: insulin resistance and cardiovascular disease. Clin Chem 2008;54(5):785-7.

18. Wang HJ, Shi LZ, Liu CF, Liu SM, Shi ST. Association between uric acid and metabolic syndrome in elderly women. Open Med (Wars) 2018;13:172-7.

19. Chang IH, Han JH, Myung SC, Kwak KW, Kim TH, Park SW, et al. Association between metabolic syndrome and chronic kidney disease in the Korean population. Nephrology (Carlton) 2009;14(3):321-6.

20. Alizadeh S, Ahmadi M, Ghorbani Nejad B, Djazayeri A, Shab-Bidar S. Metabolic syndrome and its components are associated with increased chronic kidney disease risk: evidence from a metaanalysis on 11 109 003 participants from 66 studies. Int J Clin Pract. 2018 May 23;[Epub ahead of print].

21. Thomas G, Sehgal AR, Kashyap SR, Srinivas TR, Kirwan JP, Navaneethan SD. Metabolic syndrome and kidney disease: a systematic review and metaanalysis. Clin J Am Soc Nephrol 2011;6(10):2364-73.

22. Tanner RM, Brown TM, Muntner P. Epidemiology of obesity, the metabolic syndrome, and chronic kidney disease. Curr Hypertens Rep 2012;14(2):152-9.

23. Wahba IM, Mak RH. Obesity and obesity-initiated metabolic syndrome: mechanistic links to chronic kidney disease. Clin J Am Soc Nephrol 2007;2(3):550-62.