Hyperuricemia in Young Adults and Diabetes Risk
Hyperuricemia in Young Adults and Diabetes Risk
The objective of this study was to assess the utility of hyperuricemia as a marker for diabetes and prediabetes (impaired fasting glucose) and insulin resistance in young adults. Using Cox proportional hazards regression models, the authors analyzed 15-year follow-up data on 5,012 persons in 4 US cities who were aged 18–30 years and diabetes-free at the time of enrollment. At baseline (1986), 88% of participants had a body mass index (weight (kg)/height (m)) less than 30. During the follow-up period (through 2001), the incidence rates of diabetes and prediabetes (insulin resistance and impaired fasting glucose) were higher among persons with greater serum urate concentrations. In multivariable Cox regression analyses that adjusted for age, gender, race, body mass index, family history of diabetes, diastolic blood pressure, total cholesterol, smoking, and alcohol use, the hazard ratios for diabetes, insulin resistance, and prediabetes among persons with hyperuricemia (serum urate level >7 mg/dL vs. ≤7.0 mg/dL) were 1.87 (95% confidence interval (CI): 1.33, 2.62), 1.36 (95% CI: 1.23, 1.51), and 1.25 (95% CI: 1.04, 1.52), respectively. This observation was generally consistent across subgroups. The authors conclude that hyperuricemia in the midtwenties is an independent marker for predicting diabetes and prediabetes among young adults in the subsequent 15 years.
Insulin resistance and type 2 diabetes mellitus (diabetes) have become a leading public health problem around the world. In the United States, 25.6 million persons (11.3% of the adult population) had this disease in 2010, of which there were 1.9 million newly diagnosed cases. These numbers are likely to rise over time. Diabetes doubles all-cause mortality risk and is the seventh-leading cause of death in the United States. In the year 2007, the total cost of this disease was estimated to be US$174 billion.
Diabetes may be preventable with targeted lifestyle modification interventions in high-risk individuals, but reliably identifying such people early in life is difficult. However, the population attributable risk for obesity, a known risk factor, is no more than 38%. Candidate genetic markers have been evaluated, but studies of their ability to provide additional predictive value to the existing risk scores have been inconclusive, highlighting the need for additional markers of diabetes. Many available risk scoring methods incorporate obesity and were developed in clinic-based, primarily Caucasian populations over age 35 years that were followed up for a relatively short time. These risk stratification models do not correspond to the risk models in children, an increasingly recognized age category of persons at risk for diabetes. From the perspective of diabetes prevention, it is important to establish risk factors at an age where mitigation might have the greatest impact.
Recently, hyperuricemia and gout have been proposed as novel risk factors for diabetes, but the results from epidemiologic studies have been mixed, and none examined the age group 18–30 years, in whom lifestyle interventions may be most important. In the present analysis, we prospectively studied the relation between hyperuricemia and the risk of subsequent diabetes, insulin resistance, and impaired fasting glucose (prediabetes) in young adults.
Abstract and Introduction
Abstract
The objective of this study was to assess the utility of hyperuricemia as a marker for diabetes and prediabetes (impaired fasting glucose) and insulin resistance in young adults. Using Cox proportional hazards regression models, the authors analyzed 15-year follow-up data on 5,012 persons in 4 US cities who were aged 18–30 years and diabetes-free at the time of enrollment. At baseline (1986), 88% of participants had a body mass index (weight (kg)/height (m)) less than 30. During the follow-up period (through 2001), the incidence rates of diabetes and prediabetes (insulin resistance and impaired fasting glucose) were higher among persons with greater serum urate concentrations. In multivariable Cox regression analyses that adjusted for age, gender, race, body mass index, family history of diabetes, diastolic blood pressure, total cholesterol, smoking, and alcohol use, the hazard ratios for diabetes, insulin resistance, and prediabetes among persons with hyperuricemia (serum urate level >7 mg/dL vs. ≤7.0 mg/dL) were 1.87 (95% confidence interval (CI): 1.33, 2.62), 1.36 (95% CI: 1.23, 1.51), and 1.25 (95% CI: 1.04, 1.52), respectively. This observation was generally consistent across subgroups. The authors conclude that hyperuricemia in the midtwenties is an independent marker for predicting diabetes and prediabetes among young adults in the subsequent 15 years.
Introduction
Insulin resistance and type 2 diabetes mellitus (diabetes) have become a leading public health problem around the world. In the United States, 25.6 million persons (11.3% of the adult population) had this disease in 2010, of which there were 1.9 million newly diagnosed cases. These numbers are likely to rise over time. Diabetes doubles all-cause mortality risk and is the seventh-leading cause of death in the United States. In the year 2007, the total cost of this disease was estimated to be US$174 billion.
Diabetes may be preventable with targeted lifestyle modification interventions in high-risk individuals, but reliably identifying such people early in life is difficult. However, the population attributable risk for obesity, a known risk factor, is no more than 38%. Candidate genetic markers have been evaluated, but studies of their ability to provide additional predictive value to the existing risk scores have been inconclusive, highlighting the need for additional markers of diabetes. Many available risk scoring methods incorporate obesity and were developed in clinic-based, primarily Caucasian populations over age 35 years that were followed up for a relatively short time. These risk stratification models do not correspond to the risk models in children, an increasingly recognized age category of persons at risk for diabetes. From the perspective of diabetes prevention, it is important to establish risk factors at an age where mitigation might have the greatest impact.
Recently, hyperuricemia and gout have been proposed as novel risk factors for diabetes, but the results from epidemiologic studies have been mixed, and none examined the age group 18–30 years, in whom lifestyle interventions may be most important. In the present analysis, we prospectively studied the relation between hyperuricemia and the risk of subsequent diabetes, insulin resistance, and impaired fasting glucose (prediabetes) in young adults.
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