Visceral fat obesity is highly associated with primary gout in a metabolically obese but normal weighted population: a case control study

Arthritis Research & Therapy, Mar 2015

Introduction Gout is a chronic inflammatory disease the development of which is associated with obesity-induced metabolic abnormalities. However, a substantial number of non-obese patients (body mass index [BMI] <25 kg/m2) also develop gout in Korea. It was suggested that accumulation of visceral fat rather than subcutaneous fat is associated with metabolic abnormalities and hyperuricemia in patients with gout; therefore, we hypothesized that visceral fat accumulation was increased in non-obese gout patients. Methods One hundred and three male patients with primary gout and 204 age-matched healthy controls who attended a health check-up examination were recruited after the review of medical charts. The visceral fat area (VFA) was measured using the bioelectrical impedance analysis (BIA) method, and a VFA >100 cm2 was defined as visceral fat obesity (VFO). The frequency of VFO was compared in patients and control groups. The frequencies of metabolic syndrome and related parameters were also investigated. Results BMI, waist circumference, total fat mass, serum triglycerides, and serum glucose levels were significantly greater in patients compared with controls. VFA and the prevalence of VFO was increased in gout patients compared with controls. There were positive correlations between VFA and serum triglyceride levels and serum glucose levels. Multivariate regression analysis revealed that VFO is an independent risk factor for gout (odds ratio 2.488, 95% confidence interval 1.041–4.435). In non-obese subgroup analyses (gout patients, n = 38; healthy controls, n = 150), VFA (98.7 ± 19.3 vs. 91.0 ± 16.7, P = 0.016) and the frequency of VFO (47.4 vs. 27.3%, P = 0.017) remained significantly higher in gout patients. There was no difference in either BMI or total fat mass between patients and controls in the non-obese subgroup. The prevalence of metabolic syndrome in patients with gout was 31.7% (33/104), compared with 13.2% (5/38) in the non-obese subgroup according to modified ATP III criteria. Conclusion VFO, measured using BIA, is observed more frequently in patients with primary gout compared with healthy controls, even in non-obese individuals. Therefore, VFO might more properly represent metabolic derangements in patients with gout than general obesity.

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Visceral fat obesity is highly associated with primary gout in a metabolically obese but normal weighted population: a case control study

Lee et al. Arthritis Research & Therapy Visceral fat obesity is highly associated with primary gout in a metabolically obese but normal weighted population: a case control study Jennifer Lee 0 3 Ji-Yeon Lee 0 3 Jae-Ho Lee 0 3 Seung-Min Jung 0 3 Young Sun Suh 2 Jung-Hee Koh 0 3 Seung-Ki Kwok 0 3 Ji Hyeon Ju 0 3 Kyung-Su Park 1 Sung-Hwan Park 0 3 0 Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea , Seoul St. Mary's Hospital , 222 Banpo-daero, Seocho-gu, Seoul 137-701 , Republic of Korea 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital , 93 Jungbu-daero (Ji-dong), Paldal-gu, Suwon, Gyeonggi-do 442-723 , Republic of Korea 2 Department of Internal Medicine and Institute of Health Science, Gyeongsang National University School of Medicine , 79 Gangnam-ro, Jinju 660-702 , Republic of Korea 3 Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea , Seoul St. Mary's Hospital , 222 Banpo-daero, Seocho-gu, Seoul 137-701 , Republic of Korea Introduction: Gout is a chronic inflammatory disease the development of which is associated with obesity-induced metabolic abnormalities. However, a substantial number of non-obese patients (body mass index [BMI] <25 kg/m2) also develop gout in Korea. It was suggested that accumulation of visceral fat rather than subcutaneous fat is associated with metabolic abnormalities and hyperuricemia in patients with gout; therefore, we hypothesized that visceral fat accumulation was increased in non-obese gout patients. Methods: One hundred and three male patients with primary gout and 204 age-matched healthy controls who attended a health check-up examination were recruited after the review of medical charts. The visceral fat area (VFA) was measured using the bioelectrical impedance analysis (BIA) method, and a VFA >100 cm2 was defined as visceral fat obesity (VFO). The frequency of VFO was compared in patients and control groups. The frequencies of metabolic syndrome and related parameters were also investigated. Results: BMI, waist circumference, total fat mass, serum triglycerides, and serum glucose levels were significantly greater in patients compared with controls. VFA and the prevalence of VFO was increased in gout patients compared with controls. There were positive correlations between VFA and serum triglyceride levels and serum glucose levels. Multivariate regression analysis revealed that VFO is an independent risk factor for gout (odds ratio 2.488, 95% confidence interval 1.041-4.435). In non-obese subgroup analyses (gout patients, n = 38; healthy controls, n = 150), VFA (98.7 19.3 vs. 91.0 16.7, P = 0.016) and the frequency of VFO (47.4 vs. 27.3%, P = 0.017) remained significantly higher in gout patients. There was no difference in either BMI or total fat mass between patients and controls in the non-obese subgroup. The prevalence of metabolic syndrome in patients with gout was 31.7% (33/104), compared with 13.2% (5/38) in the non-obese subgroup according to modified ATP III criteria. Conclusion: VFO, measured using BIA, is observed more frequently in patients with primary gout compared with healthy controls, even in non-obese individuals. Therefore, VFO might more properly represent metabolic derangements in patients with gout than general obesity. - Introduction Gout is a prototypic of crystal-induced arthropathy caused by monosodium urate (MSU) crystal precipitation in joints. Although the precise mechanism of disease pathogenesis remains unclear, hyperuricemia is a prerequisite of gout development. In addition, the inflammasome, intracellular machinery related to innate immunity, plays an important role in producing IL-1, which is the critical cytokine for MSU-induced gout inflammation [1]. The history of gout spans thousands of years, and it was historically referred to as a kings disease because its development is closely associated with the consumption of large amounts of fatty foods and alcohol, as well as obesity. Indeed, several studies reported a close relationship between fat accumulation and gout/hyperuricemia [2-6]. Furthermore, gout patients are not only obese but also commonly have obesity-associated comorbidities such as high blood pressure, hypertriglyceridemia, or impaired fasting glucose, which together comprise metabolic syndrome [7]. In line with this, the prevalence of metabolic syndrome is higher in gout patients compared with the general population [8-14]. These observations suggest that obesity is a strong risk factor for the development of gout. However, in Korea, there are a substantial number of non-obese gout patients (body mass index (BMI) <25 kg/m2). It was suggested that the accumulation of visceral fat rather than subcutaneous fat is associated with metabolic abnormalities and hyperuricemia in patients with gout [4]; therefore, we (...truncated)


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Jennifer Lee, Ji-Yeon Lee, Jae-Ho Lee, Seung-Min Jung, Young Suh, Jung-Hee Koh, Seung-Ki Kwok, Ji Ju, Kyung-Su Park, Sung-Hwan Park. Visceral fat obesity is highly associated with primary gout in a metabolically obese but normal weighted population: a case control study, Arthritis Research & Therapy, 2015, pp. 79, 17, DOI: 10.1186/s13075-015-0593-6