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Lipids in Health and Disease

, 18:147 | Cite as

Age-related and gender-stratified differences in the association between high triglyceride and risk of hyperuricemia

  • Lei Zhang
  • Qilin Wan
  • Yuemin Zhou
  • Jing Xu
  • Chengyun Yan
  • Yuanyuan Ma
  • Minglong Xu
  • Ruili He
  • Yanming Li
  • Xiaoming Zhong
  • Guanchang ChengEmail author
  • Yuquan LuEmail author
Open Access
Research
  • 114 Downloads

Abstract

Background

Elevated serum uric acid is commonly associated with high triglyceride. However, the relation of triglyceride and hyperuricemia in different gender and age groups is currently not well understood. This study aimed to evaluate age- and gender-related association of high triglyceride with hyperuricemia in a subgroup of Chinese population.

Methods

We retrospectively analyzed physical examination data of 24,438 subjects (12,557 men and 11,881 women) in Kaifeng, China. The alanine aminotransferase, γ-glutamyl transpeptidase, serum creatinine, blood urea nitrogen, total cholesterol, high-density lipoprotein cholesterol, triglyceride and serum uric acid were measured in all subjects. The triglyceride was categorized into < 1.21, 1.21 ~, 1.7 ~, 2.83 ~ and >  5.6 mmol/L subgroups, and odds ratio (OR) and 95% confidence interval (CI) of hyperuricemia were calculated by logistic regression analysis.

Results

Univariate and age-adjusted analyses showed that high triglyceride was positively associated with hyperuricemia (p <  0.01). Further age-stratified analysis showed that the positive association was significant in the 20 ~, 30 ~, 40 ~, 50 ~, 60 ~ and 80 ~ age groups in men. In women, no statistically significant was found in 60 ~ and 70 ~ age groups.

Conclusion

High triglyceride is positively associated with hyperuricemia in both men and women, and this association is age-related, especially in women.

Keywords

Hyperuricemia Triglyceride Risk Age-related 

Abbreviations

ALT

Alanine aminotransferase

BUN

Blood urea nitrogen

HDL-C

High-density lipoprotein cholesterol

SCr

Serum creatinine

TC

Total cholesterol

TG

Triglyceride

UA

Uric acid

γ-GT

γ-glutamyl transpeptidase

Background

Hyperuricemia is widely considered as a key risk factor for metabolic syndrome, including dyslipidemia, in which hypertriglyceridemia is the most common lipid abnormality [1, 2, 3, 4, 5, 6]. High uric acid (UA) levels were associated with increased triglyceridemia, independently of metabolic syndrome [7]. A survey of the prevalence of obesity in China during 2004 to 2008 showed that all rural areas had a low prevalence of obesity except in Henan, probably because of differences in diet [8]. Furthermore, a recent meta-analysis evaluating 302,430 individuals free of known vascular disease at baseline in 68 prospective studies showed that high triglyceride had a strong association with both cardiovascular disease and ischemic stroke [9]. In addition, the secondary prevention of those diseases and antihyperuricemic therapy involve long term and high costs [10, 11, 12]. Therefore, if we can identify the link of triglycerides with hyperuricemia in different age groups, more people will benefit.

Liou et al. reported that uric acid aggregated with log value of triglycerides but concluded that metabolic syndrome was not associated with hyperuricemia [13]. However, an Indian study enrolling 121 healthy men suggested that serum uric acid level was a good indicator of the level of triglyceride [14]. At present, little is known whether serum uric acid level and high triglyceride has the similar relationship in Chinese in different age-groups. Therefore, this study aimed to investigate the association of high triglyceride with the risk of hyperuricemia in different genders and age-groups using physical examination data from a hospital-based physical examination center in Kaifeng, China.

Methods

Subjects

This study was approved by Ethics Committee of Huaihe Hospital of Henan University and all subjected provided written consent. The subjects were participants of physical examination at the Physical Examination Center of Huaihe Hospital of Henan University. Total number of the subjects were 38,475 consecutive participants from 2003 to 2017. After excluding subjects without available data on age, gender, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GT), blood urea nitrogen (BUN) and serum creatinine (SCr), a total of 24,438 eligible subjects (12,557 men and 11,881 women) were included in the final analysis (Fig. 1).
Fig. 1

Flow chart of participants

Serum uric acid and lipids measurements

Blood samples from participants undergoing an overnight fasting were collected in the morning and analyzed within an hour in hospital. Blood sample was tested using an autoanalyzer (Model 7600, HITACHI, Japan). Hyperuricemia was defined by the following criteria: men: serum uric acid ≥440 μmol/L, women: serum uric acid ≥360 μmol/L and categorized all the variables as follows: the plasma triglyceride were categorized into < 1.21 (normal), 1.21 ~ (above normal), 1.7 ~ (slightly damaged), 2.83 ~ (moderately damaged) and >  5.6 mmol/L (severely damaged) subgroups, and we combined the slightly, moderately, and severely damaged TG into a Damaged TG group; age was categorized into < 20, 20 ~, 30 ~, 40 ~, 50 ~, 60 ~, 70 ~, and 80 ~ years age subgroups; ALT was dichotomized into normal (≤ 40 U/L) and abnormal (> 40 U/L) subgroups; γ-GT was categorized into low (< 16 U/L), normal (16 ~ 73 U/L) and high (> 73 U/L) subgroups; SCr was categorized into low (men: < 54 mmol/L, women: < 44 mmol/L), normal (men: 54 ~ 106 mmol/L, women: 44 ~ 97 mmol/L) and high (men: > 106 mmol/L, women: > 97 mmol/L) subgroups; BUN was categorized into low (< 2.86 μmol/L), normal (2.86 ~ 7.14 μmol/L) and high (> 7.14 μmol/L) subgroups; TC was categorized into low (< 2.8 mmol/L), normal (2.8 ~ 5.17 mmol/L) and high subgroups (> 5.17 mmol/L); plasma glucose was categorized into low FPG (< 3.9 mmol/L), normal FPG (3.9 ~ mmol/L), impaired FPG (6.1 ~ mmol/L) and diabetic FPG (> 7.0 mmol/L) subgroups; and HDL-C was categorized into low (< 0.9 mmol/L), normal (0.9 ~ 2.19 mmol/L) and high (> 2.19 mmol/L) subgroups.

Statistical analysis

Statistical analysis was performed using Stata version 13 (StataCorp LLC, TX, USA). The chi-squared test was used to analyze the differences in the distribution of TG categories. Three models with progressive degrees of adjustment were used to evaluate the relationship between hyperuricemia with TG for men and women, separately. Model 1 was a univariate logistic regression model; Model 2 was an age-adjusted logistic regression model, and Model 3 was a multivariate logistic regression model (adjusted for age, ALT, γ-GT, SCr, BUN, TC, FPG, and HDL-C). Multivariable logistic regression analysis were used to calculate age-stratified association of TG and hyperuricemia for both men and women. Odds ratio (OR) and 95% confidence intervals (CI) were estimated in the logistical regression analysis. p <  0.05 was considered significant.

Results

We observed an increasing trend in the proportion of the Damaged TG group when the age increased from 20 to 40 years; thereafter, the proportion of the Damaged TG group started to decrease with age in men (Fig. 2). There was a growing trend of the proportion of the Damaged TG group among women with a flat plateau from 60 years of age (Fig. 3).
Fig. 2

Changes of triglyceride levels with age in men

Fig. 3

Changes of triglyceride levels with age in women

In Table 1, the Damaged TG group (1.7 ~, 2.83 ~ and >  5.6 mmol/L subgroups) had a higher proportion to have high levels of serum ALT, γ-GT, TC and hyperuricemia (all p <  0.05), but had a lower proportion to have high level of serum HDL-C (p <  0.001) in both genders.
Table 1

Characteristics of the participants of physical examinations by fasting plasma triglyceride categories (mmol/L) in men and women

 

Men, fasting plasma triglyceride (mmol/L)

Women, fasting plasma triglyceride (mmol/L)

No. of participants

<  1.21

1.21 ~

1.7 ~

2.83 ~

>  5.6

P-value

No. of participants

<  1.21

1.21 ~

1.7 ~

2.83 ~

>  5.6

P-value

No. of participants

12,557

4293 (34.2)

3040 (24.2)

3335 (26.6)

1546 (12.3)

343 (2.7)

 

11,881

6023 (50.7)

2661 (22.4)

2353 (19.8)

747 (6.3)

97 (0.8)

 

Age (years), n (%)

 < 20

43

33 (76.7)

4 (9.3)

5 (11.6)

0 (0.0)

1 (2.3)

<  0.001

22

17 (77.3)

3 (13.6)

2 (9.1)

0 (0.0)

0 (0.0)

<  0.001

 20 ~

1325

609 (46.0)

324 (24.5)

244 (18.4)

125 (9.4)

23 (1.7)

 

1880

1335 (71.0)

264 (14.0)

190 (10.1)

81 (4.3)

10 (0.5)

 

 30 ~

2348

702 (29.9)

540 (23.0)

669 (28.5)

342 (14.6)

95 (4.1)

 

2485

1582 (63.7)

473 (19.0)

324 (13.0)

89 (3.6)

17 (0.7)

 

 40 ~

3133

858 (27.4)

704 (22.5)

938 (29.9)

505 (16.1)

128 (4.1)

 

2652

1496 (56.4)

578 (21.8)

436 (16.4)

128 (4.8)

14 (0.5)

 

 50 ~

2735

879 (32.1)

680 (24.9)

764 (27.9)

349 (12.8)

63 (2.3)

 

2492

904 (36.3)

679 (27.3)

654 (26.2)

224 (9.0)

31 (1.2)

 

 60 ~

1848

684 (37.0)

474 (25.7)

510 (27.6)

157 (8.5)

23 (1.2)

 

1509

424 (28.1)

441 (29.2)

480 (31.8)

146 (9.7)

18 (1.2)

 

 70 ~

848

386 (45.5)

233 (27.5)

166 (19.6)

56 (6.6)

7 (0.8)

 

679

214 (31.5)

172 (25.3)

222 (32.7)

64 (9.4)

7 (1.0)

 

 80 ~

277

142 (51.3)

81 (29.2)

39 (14.1)

12 (4.3)

3 (1.1)

 

162

51 (31.5)

51 (31.5)

45 (27.8)

15 (9.3)

0 (0.0)

 

Alanine Aminotransferase (U/L), n (%)

 <= 40

10,864

3974 (36.6)

2694 (24.8)

2812 (25.9)

1165 (10.7)

219 (2.0)

<  0.001

11,289

5856 (51.9)

2514 (22.3)

2172 (19.2)

661 (5.9)

86 (0.8)

<  0.001

 >  40

1693

319 (18.8)

346 (20.4)

523 (30.9)

381 (22.5)

124 (7.3)

 

592

167 (28.2)

147 (24.8)

181 (30.6)

86 (14.5)

11 (1.9)

 

γ-Glutamyl Transpeptidase (U/L), n (%)

 <  16

1722

1102 (64.0)

375 (21.8)

200 (11.6)

39 (2.3)

6 (0.4)

<  0.001

6207

4088 (65.9)

1253 (20.2)

716 (11.5)

138 (2.2)

12 (0.2)

<  0.001

 16 ~  73

9724

3077 (31.6)

2509 (25.8)

2766 (28.5)

1168 (12.0)

204 (2.1)

 

5488

1892 (34.5)

1364 (24.9)

1578 (28.8)

575 (10.5)

79 (1.4)

 

 >  73

1111

114 (10.3)

156 (14.0)

369 (33.2)

339 (30.5)

133 (12.0)

 

186

43 (23.1)

44 (23.7)

59 (31.7)

34 (18.3)

6 (3.2)

 

Serum Creatinine (mmol/L), n (%)

 Men < 54 or Women < 44

719

281 (39.1)

143 (19.9)

168 (23.4)

89 (12.4)

38 (5.3)

<  0.001

1383

688 (49.8)

311 (22.5)

261 (18.9)

107 (7.7)

16 (1.2)

<  0.001

 Men: 54~106 or Women: 44~97

11,715

3978 (34.0)

2862 (24.4)

3143 (26.8)

1431 (12.2)

301 (2.6)

 

10,461

5325 (50.9)

2339 (22.4)

2085 (19.9)

632 (6.0)

80 (0.8)

 

 Men > 106 or Women > 97

123

34 (27.6)

35 (28.5)

24 (19.5)

26 (21.1)

4 (3.3)

 

37

10 (27.0)

11 (29.7)

7 (18.9)

8 (21.6)

1 (2.7)

 

Blood Urea Nitrogen (μmol/L), n (%)

 <  2.86

101

36 (35.6)

23 (22.8)

26 (25.7)

12 (11.9)

4 (4.0)

<  0.001

523

300 (57.4)

110 (21.0)

81 (15.5)

30 (5.7)

2 (0.4)

0.027

 2.86 ~  7.14

11,465

3853 (33.6)

2779 (24.2)

3103 (27.1)

1420 (12.4)

310 (2.7)

 

11,016

5570 (50.6)

2469 (22.4)

2196 (19.9)

690 (6.3)

91 (0.8)

 

 >  7.14

991

404 (40.8)

238 (24.0)

206 (20.8)

114 (11.5)

29 (2.9)

 

342

153 (44.7)

82 (24.0)

76 (22.2)

27 (7.9)

4 (1.2)

 

Total Cholesterol (mmol/L), n (%)

 <  2.8

82

66 (80.5)

12 (14.6)

3 (3.7)

1 (1.2)

0 (0.0)

<  0.001

44

34 (77.3)

6 (13.6)

4 (9.1)

0 (0.0)

0 (0.0)

<  0.001

 2.8 ~  5.17

7665

3252 (42.4)

1878 (24.5)

1777 (23.2)

671 (8.8)

87 (1.1)

 

7273

4561 (62.7)

1425 (19.6)

970 (13.3)

287 (4.0)

30 (0.4)

 

 >  5.17

4810

975 (20.3)

1150 (23.9)

1555 (32.3)

874 (18.2)

256 (5.3)

 

4564

1428 (31.3)

1230 (27.0)

1379 (30.2)

460 (10.1)

67 (1.5)

 

Fasting plasma glucose (mmol/L), n (%)

 <  3.9

20

9 (45.0)

6 (30.0)

2 (10.0)

3 (15.0)

0 (0.0)

 

20

9 (45.0)

5 (25.0)

3 (15.0)

2 (10.0)

1 (5.0)

<  0.001

 3.9 ~

9833

3591 (36.5)

2447 (24.9)

2521 (25.6)

1062 (10.8)

212 (2.2)

<  0.001

10,194

5607 (55.0)

2217 (21.8)

1814 (17.8)

497 (4.9)

59 (0.6)

 

 6.1 ~

1370

368 (26.9)

309 (22.6)

416 (30.4)

218 (15.9)

59 (4.3)

 

933

245 (26.3)

263 (28.2)

290 (31.1)

119 (12.8)

16 (1.7)

 

 >  7.0

1334

325 (24.4)

278 (20.8)

396 (29.7)

263 (19.7)

72 (5.4)

 

734

162 (22.1)

176 (24.0)

246 (33.5)

129 (17.6)

21 (2.9)

 

High Density Lipoprotein Cholesterol (mmol/L), n (%)

 <  0.9

2274

371 (16.3)

465 (20.5)

775 (34.1)

502 (22.1)

161 (7.1)

<  0.001

709

98 (13.8)

134 (18.9)

234 (33.0)

197 (27.8)

46 (6.5)

<  0.001

 0.9 ~  2.19

10,262

3904 (38.0)

2573 (25.1)

2559 (24.9)

1044 (10.2)

182 (1.8)

 

11,093

5865 (52.9)

2514 (22.7)

2115 (19.1)

548 (4.9)

51 (0.5)

 

 >  2.19

21

18 (85.7)

2 (9.5)

1 (4.8)

0 (0.0)

0 (0.0)

 

79

60 (76.0)

13 (16.5)

4 (5.1)

2 (2.5)

0 (0.0)

 

Hyperuricemia (men > 440 μmol/L or women > 360 μmol/L)

 No

11,305

4068 (36.0)

2791 (24.7)

2948 (26.1)

1246 (11.0)

252 (2.2)

<  0.001

11,193

5877 (52.5)

2507 (22.4)

2112 (18.9)

614 (5.5)

83 (0.7)

<  0.001

 Yes

1252

225 (18.0)

249 (19.9)

387 (30.9)

300 (24.0)

91 (7.3)

 

688

146 (21.2)

154 (22.4)

241 (35.0)

133 (19.3)

14 (2.0)

 
Univariate logistical regression analysis (Model 1) in men showed that the above normal, slightly damaged, moderately damaged and severely damaged TG subgroups had an OR of 1.61 (95% CI: 1.34–1.94), 2.37 (95% CI: 2.00–2.82), 4.35 (95% CI: 3.62–5.23), and 6.53 (95% CI: 4.96–8.59), respectively; age-adjusted logistical regression analysis (Model 2) and multivariate logistical regression model (Model 3) showed a similar trend (Table 2). In all three models, the OR of hyperuricemia was positively associated with an increase in TG (p <  0.001). In women, age-adjusted logistic regression analysis showed a similar trend to that of univariate logistic regression model, in accordance with the results in men. Moderately damaged and severely damaged TG subgroups in Model 3 showed an OR of 5.42 (95% CI: 4.03–7.28) and 4.01 (95% CI: 2.13–7.55), respectively. In women, all the three models showed that TG was positively associated with risk for hyperuricemia (all p <  0.001).
Table 2

Odds ratio of hyperuricemia among fasting plasma triglyceride (mmol/L) in men and womena

 

Men, fasting plasma triglyceride (mmol/L)

Women, fasting plasma triglyceride (mmol/L)

<  1.21

1.21 ~

1.7 ~

2.83 ~

>  5.6

P for trendb

<  1.21

1.21 ~

1.7 ~

2.83 ~

>  5.6

P for trendb

No. of participants

4293

3040

3335

1546

343

 

6023

2661

2353

747

97

 

Hyperuricemiac

 Cases

225

249

387

300

91

 

146

154

241

133

14

 

 Rate (%)

5.2

8.2

11.6

19.4

26.5

 

2.4

5.8

10.2

17.8

14.4

 

 Model 1, OR (95% CI)

1.00

1.61 (1.34–1.94)

2.37 (2.00–2.82)

4.35 (3.62–5.23)

6.53 (4.96–8.59)

0.000

1.00

2.47 (1.96–3.12)

4.59 (3.72–5.68)

8.72 (6.80–11.19)

6.79 (3.77–12.24)

0.000

 Model 2, OR (95% CI)

1.00

1.62 (1.35–1.96)

2.37 (2.00–2.81)

4.26 (3.54–5.12)

6.26 (4.76–8.25)

0.000

1.00

2.35 (1.86–2.97)

4.28 (3.44–5.33)

8.16 (6.33–10.53)

6.43 (3.56–11.61)

0.000

 Model 3, OR (95% CI)

1.00

1.46 (1.21–1.77)

1.99 (1.65–2.39)

3.10 (2.51–3.82)

4.27 (3.13–5.83)

0.000

1.00

1.95 (1.53–2.50)

3.20 (2.51–4.08)

5.42 (4.03–7.28)

4.01 (2.13–7.55)

0.000

aLogistic regression. Model 1, univariate; Model 2, adjusted with age; Model 3, adjusted with age, alanine aminotransferase (U/L), γ-glutamyl transpeptidase (U/L), serum creatinine (mmol/L), blood urea nitrogen (μmol/L), total cholesterol (mmol/L), plasma glucose (mmol/l), and high density lipoprotein cholesterol (mmol/L). OR Odds ratio, CI Confidence interval

bContrasts of marginal linear predictions after logistic regression with Stata13

cHyperuricemia:(men > 440 μmol/L or women > 360 μmol/L

Multivariate logistic regression model showed that the positive association between hyperuricemia and TG was significant in men of 20~, 30 ~, 40 ~, 50 ~, 60 ~ and 80 ~ age subgroups (p <  0.05, Table 3). Increase in hyperuricemia in the severely damaged TG group was more significant for the 60~ age subgroup (OR = 12.07; 95% CI: 3.63–40.16). In women, the positive association was the lowest in the 50~ age group with increase in TG. No significant increase in hyperuricemia was observed in the 60 ~ (women) and 70 ~ (women and men) age groups (p > 0.05).
Table 3

Odds ratio of hyperuricemia among fasting plasma triglyceride (mmol/L) and age in men and womena

 

Men, fasting plasma triglyceride (mmol/L)

Women, fasting plasma triglyceride (mmol/L)

No. of participants

Case

Rate (%)

<  1.21

1.21 ~

1.7 ~

2.83 ~

>  5.6

P for trendb

No. of participants

Case

Rate (%)

<  1.21

1.21 ~

1.7 ~

2.83 ~

>  5.6

P for trendb

No. of participants

12,557

1252

10.0

4293

3040

3335

1546

343

 

11,881

688

5.8

6023

2661

2353

747

97

 

Hyperuricemiac

 < 20 yrs

43

10

23.3

1.00

(−)

(−)

(−)

(−)

(−)

22

3

13.6

1.00

(−)

(−)

(−)

(−)

(−)

 20~ yrs

1325

175

13.2

1.00

1.02 (0.63–1.64)

1.50 (0.92–2.45)

2.40 (1.36–4.23)

3.03 (1.11–8.22)

0.005

1880

116

6.2

1.00

2.26 (1.26–4.03)

2.17 (1.13–4.16)

5.98 (2.79–12.83)

7.42 (1.43–38.36)

0.004

 30~ yrs

2348

304

12.9

1.00

1.70 (1.11–2.59)

1.78 (1.18–2.70)

3.10 (1.95–4.91)

3.88 (2.06–7.30)

0.000

2485

107

4.3

1.00

3.01 (1.74–5.20)

3.22 (1.75–5.90)

6.64 (3.11–14.16)

8.10 (2.10–31.17)

0.000

 40~ yrs

3133

288

9.2

1.00

1.80 (1.10–2.93)

3.22 (2.06–5.02)

4.92 (3.03–7.99)

6.73 (3.58–12.68)

0.000

2652

74

2.8

1.00

3.48 (1.76–6.86)

3.95 (1.91–8.18)

6.13 (2.40–15.64)

(−)

0.001

 50~ yrs

2735

241

8.8

1.00

1.38 (0.88–2.15)

2.04 (1.34–3.11)

4.07 (2.57–6.45)

7.48 (3.77–14.85)

0.000

2492

159

6.4

1.00

1.58 (0.94–2.66)

2.31 (1.38–3.86)

4.12 (2.26–7.49)

5.07 (1.71–15.00)

0.000

 60~ yrs

1848

123

6.7

1.00

2.20 (1.16–4.15)

4.17 (2.29–7.59)

5.43 (2.57–11.45)

12.07 (3.63–40.16)

0.000

1509

123

8.2

1.00

0.82 (0.38–1.76)

3.79 (1.99–7.22)

5.59 (2.64–11.85)

1.15 (0.13–10.08)

0.549

 70~ yrs

848

81

9.6

1.00

1.12 (0.58–2.16)

1.07 (0.51–2.25)

1.48 (0.55–3.99)

4.46 (0.70–28.41)

0.096

679

78

11.5

1.00

1.53 (0.68–3.41)

2.82 (1.34–5.97)

1.06 (0.33–3.40)

(−)

0.570

 80~ yrs

277

30

10.8

1.00

4.80 (1.58–14.56)

5.04 (1.26–20.19)

10.13 (1.58–64.80)

(−)

0.018

162

28

17.3

1.00

1.70 (0.32–8.87)

3.75 (0.71–19.67)

16.75 (2.26–124.18)

(−)

0.006

aLogistic regression model adjusted with alanine aminotransferase (U/L), γ-glutamyl transpeptidase (U/L), serum creatinine (mmol/L), blood urea nitrogen (μmol/L), total cholesterol (mmol/L), plasma glucose (mmol/L), and high density lipoprotein cholesterol (mmol/L)

bContrasts of marginal linear predictions from 3.9~ though > 7.0 groups after logistic regression with Stata13

cHyperuricemia:(men > 440 μmol/L or women > 360 μmol/L

Considering the complicated relationship between triglyceride and glucose metabolism, we also analyzed the association of triglyceride-glucose index (TyG) with hyperuricemia. The results showed that TyG tended to be a better index of hyperuricemia in females than in males (Table 4). After being stratified by the age, the better behavior of TyG was concentrated in 40~ and 60~ age groups (Table 5).
Table 4

Odds ratio of hyperuricemia among triglyceride-glucose index in men and womena

 

Men, triglyceride-glucose index (TyG)

Women, triglyceride-glucose index (TyG)

0 ~

1st quatile ~

2nd quatile ~

3rd quatile ~

P for trendb

0 ~

1st quatile ~

2nd quatile ~

3rd quatile ~

P for trendb

No. of  participants

2169

3034

3410

3944

 

3924

3057

2701

2199

 

Hyperuricemiac

 Cases

103

199

333

617

 

67

114

198

309

 

 Rate (%)

4.7

6.6

9.8

15.6

 

1.7

3.7

7.3

14.1

 

 Model 1, OR (95% CI)

1.00

1.40 (1.10–1.79)

2.16 (1.72–2.72)

3.72 (3.00–4.62)

<  0.001

1.00

2.23 (1.64–3.33)

4.53 (3.41–6.71)

9.41 (7.19–12.33)

<  0.001

 Model 2, OR (95% CI)

1.00

1.47 (1.15–1.88)

2.26 (1.80–2.85)

3.90 (3.14–4.84)

<  0.001

1.00

2.19 (1.61–2.98)

4.39 (3.29–5.86)

9.08 (6.85–12.72)

<  0.001

 Model 3, OR (95% CI)

1.00

1.32 (1.03–1.72)

1.85 (1.46–2.35)

2.68 (2.11–3.41)

<  0.001

1.00

1.90 (1.39–2.61)

3.32 (2.44–4.52)

6.08 (4.43–8.34)

<  0.001

aLogistic regression. Model 1, univariate; Model 2, adjusted with age; Model 3, adjusted with age, alanine aminotransferase (U/L), γ-glutamyl transpeptidase (U/L), serum creatinine (mmol/L), blood urea nitrogen (μmol/L), total cholesterol (mmol/L), and high density lipoprotein cholesterol (mmol/L). OR Odds ratio, CI Confidence interval

bContrasts of marginal linear predictions after logistic regression with Stata13

cHyperuricemia:(men > 440 μmol/L or women > 360 μmol/L

Table 5

Odds ratio of hyperuricemia among triglyceride-glucose index and age in men and womena

 

Men, triglyceride-glucose index (TyG)

Women, triglyceride-glucose index (TyG)

No. of participants

Case

Rate (%)

0 ~

1st quatile ~

2nd quatile ~

3rd quatile ~

P for trendb

No. of participants

Case

Rate (%)

0 ~

1st quatile ~

2nd quatile ~

3rd quatile ~

P for trendb

No. of participants

12,557

1252

10.0

2169

3034

3410

3944

 

11,881

688

5.8

3924

3057

2701

2199

 

Hyperuricemiac

 < 20 yrs

43

10

23.3

1.00

4.98 (0.37–66.42)

73.31 (1.18–4529.68)

7.78 (0.20–297.59)

0.135

22

3

13.6

1.00

(−)

(−)

(−)

(−)

 20~ yrs

1325

175

13.2

1.00

1.19 (0.70–2.77)

1.29 (0.76–2.18)

2.44 (1.41–4.24)

0.002

1880

116

6.2

1.00

2.77 (1.50–5.97)

2.49 (1.23–5.23)

5.72 (2.82–11.61)

<  0.001

 30~ yrs

2348

304

12.9

1.00

1.30 (0.77–2.21)

1.83 (1.11–3.32)

2.27 (1.36–3.78)

<  0.001

2485

107

4.3

1.00

1.89 (0.96–3.69)

4.15 (2.18–7.89)

5.95 (2.92–12.11)

<  0.000

 40~ yrs

3133

288

9.2

1.00

0.98 (0.51–1.89)

2.03 (1.13–3.65)

3.77 (2.12–6.72)

<  0.001

2652

74

2.8

1.00

3.61 (1.29–13.86)

9.42 (3.42–25.97)

11.42 (3.87–33.73)

<  0.001

 50~ yrs

2735

241

8.8

1.00

1.54 (0.81–2.93)

1.92 (1.04–3.54)

3.31 (1.80–6.75)

<  0.001

2492

159

6.4

1.00

0.91 (0.46–1.79)

1.64 (0.87–3.57)

2.86 (1.51–5.42)

0.002

 60~ yrs

1848

123

6.7

1.00

3.17 (1.06–9.46)

4.90 (1.67–14.37)

6.46 (2.19–19.53)

<  0.001

1509

123

8.2

1.00

2.27 (0.62–8.31)

3.98 (1.18–13.47)

10.67 (3.17–35.98)

<  0.001

 70~ yrs

848

81

9.6

1.00

1.48 (0.62–3.54)

1.35 (0.54–3.36)

1.34 (0.53–3.41)

0.600

679

78

11.5

1.00

0.97 (0.30–3.14)

1.60 (0.53–4.78)

2.25 (0.74–6.83)

0.198

 80~ yrs

277

30

10.8

1.00

1.39 (0.29–6.72)

6.16 (1.51–25.72)

3.68 (0.72–18.71)

0.035

162

28

17.3

(−)

1.00

3.08 (0.67–14.27)

5.24 (1.10–24.87)

0.321

aLogistic regression model adjusted with alanine aminotransferase (U/L), γ-glutamyl transpeptidase (U/L), serum creatinine (mmol/L), blood urea nitrogen (μmol/L), total cholesterol (mmol/L), and high density lipoprotein cholesterol (mmol/L)

bContrasts of marginal linear predictions from 3.9~ though > 7.0 groups after logistic regression with Stata13

cHyperuricemia: men > 440 μmol/L or women > 360 μmol/L

Discussion

In this study, we found a positive relationship of high triglyceride with hyperuricemia in both men and women, in agreement with an Indian study [14]. Dietary habits have been changing in both China and India, and obesity and hypertriglyceridemia have begun to occur in younger people.

The relationship of serum uric acid with triglyceridemia is still controversial. Earlier studies showed that hyperuricemia was always accompanied with hypertriglyceridemia initially [15, 16]. In addition, TG was more strongly associated with serum UA than HDL-C and TC, using the healthy examination data [17]. A Kuwait study further supported the close relation in dyslipidemic patients, a group already at high coronary artery disease risk [18]. Nevertheless, whether age and gender differences mediate the association between serum UA levels and TG is still controversial. In present study, we demonstrated that after adjustment with age (Model 2) and other confounding factors (Model 3), the OR still increased with the increase in TG. These results suggest that TG levels independently affect the incidence of hyperuricemia. However, in multivariate logistic regression analysis, the positive association between hyperuricemia and TG showed a gender and age differences and the positive association was the lowest in the 50~ age group. Whether decreasing level of estrogen after menopause is responsible for the differences needs further studies.

Stelmach et al. investigated 607 Polish adults with hyperuricemia and demonstrated that the upper tertile of serum uric acid levels had higher TG values in males but not in females [19]. In contrast, Lippi et al. retrospectively enrolled a large cohort of unselected adult outpatients and showed that triglycerides were independently associated with serum UA in women but not in men [20]. Notably, in this study our data showed that high TG level was positively associated with the incidence of hyperuricemia in both men and women. This is consistent with a prospective study which demonstrated that hypertriglyceridemia in men might strengthen the effect of serum UA on the development of gout [21]. Chinese diet is characterized with a high-fat diet, particularly the overconsumption of cooking oil may be a significant risk factor for obesity [22, 23].

To investigate lipid abnormalities in acute myocardial infarction (AMI) patients, Wei et al. retrospectively analyzed 1213 AMI patients in East China and showed a significant difference in triglycerides for male but not for female AMI patients [24]. Xu et al. found that older Chinese people had moderate and high levels of unbalanced diets [25]. Significant differences were influenced by many factors, such as gender, marital status, work status, education levels. These findings highlight complex interaction between hyperuricemia and TG. Differences in dietary patterns such as the proportion of carbohydrate or fat may be responsible for the variability in the relationship between serum uric acid and triglyceridemia.

TyG index is proposed as a marker of moderate insulin resistance. Therefore, we analyzed the association of TyG with hyperuricemia. We found that TyG could be a better index of hyperuricemia in females than in males. However, a recent study indicated that TyG index presented the significant risks for chronic kidney disease in both men and women [26]. The reason for the disparities is unclear and need additional investigations.

Our study has two main limitations. First, our study was conducted in a special group, so the generalizability of our findings to other population needs confirmation in future studies. Second, confounding factors such as diet patterns and health concerns among people of different ages were not included in our analysis, which may have an impact on the results. Further studies are required to elucidate the association between triglyceride and hyperuricemia in different gender and age groups.

Conclusions

Our study demonstrated that high triglyceride was positively associated with hyperuricemia in both men and women, and this association was age-related, especially in women.

Notes

Acknowledgements

We thank all of participants in this study.

Authors’ contributions

GC and YL designed the study. LZ, QW, YZ, JX, CY, YM, MX, RH collected the data. YL and XZ analyzed the data. LZ and GC wrote the manuscript. All authors read and approved the final manuscript.

Funding

This work was supported by the Scientific and Technological Project of Henan Province (No. 201502017).

Ethics approval and consent to participate

This study was approved by Ethics Committee of Huaihe Hospital of Henan University and all subjected provided written consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Lei Zhang
    • 1
  • Qilin Wan
    • 1
  • Yuemin Zhou
    • 2
  • Jing Xu
    • 1
  • Chengyun Yan
    • 1
  • Yuanyuan Ma
    • 2
  • Minglong Xu
    • 3
  • Ruili He
    • 1
  • Yanming Li
    • 1
  • Xiaoming Zhong
    • 1
  • Guanchang Cheng
    • 1
    Email author
  • Yuquan Lu
    • 2
    Email author
  1. 1.Department of CardiologyHuaihe Hospital of Henan UniversityKaifengChina
  2. 2.International Joint Research Laboratory for Cell Medical Engineering of HenanHuaihe Hospital of Henan UniversityKaifengChina
  3. 3.Department of Physical Examination CenterHuaihe Hospital of Henan UniversityKaifengChina

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