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      Relation of uric acid with components of metabolic syndrome before and after Roux-en-Y gastric bypass in morbidly obese subjects Translated title: Relação do ácido úrico com os componentes da síndrome metabólica antes e após o bypass gástrico com reconstrução em Y-de-Roux em pacientes obesos mórbidos

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          Abstract

          OBJECTIVE: The purpose of the study was to investigate the prevalence of hyperuricemia in morbidly obese subjects before and after Roux-en-Y gastric bypass (RYGBP) and its relationship with metabolic syndrome abnormalities. SUBJECTS AND METHOD: We evaluated 420 morbidly obese patients. Pre and postoperative (8 months after RYGBP) blood samples were drawn. Obese patients underwent laparoscopic RYGBP and after eight months all the tests were repeated. RESULTS: The overall prevalence of hyperuricemia was 34.28%. Hyperuricemia was more common in men than in women (51.72 vs. 29.72%; p = 0.0002). Men with hyperuricemia were more likely to have diabetes (p = 0.034) and more elevated fasting plasma glucose levels (p = 0.027). Women with hyperuricemia were more likely to have hypertension (p = 0.003), metabolic syndrome (p = 0.001), elevated triglycerides (p = 0.001) and GGT (p = 0.009), and decreased HDL (p = 0.011). After surgery, uric acid levels decreased from 5.60 ± 1.28 to 4.23 ± 1.20 (p < 0.0001). The prevalence of hyperuricemia decreased from 33.6% to 6.4% (p < 0.0001), in men from 48.3% to 17.2% (p < 0.0001) and in women from 29.7% to 3.6% (p < 0.0001). CONCLUSION: Concentrations of uric acid were associated with the prevalence of metabolic abnormalities in this sample of morbidly obese patients. Also, weight loss after RYGBP can reduce uric acid levels and the prevalence of hyperuricemia.

          Translated abstract

          OBJETIVO: O objetivo do estudo foi investigar a prevalência de hiperuricemia em pacientes obesos mórbidos antes e após o bypass gástrico com reconstrução em Y-de-Roux (RYGBP) e sua relação com anormalidades da síndrome metabólica. SUJEITOS E MÉTODOS: Foram avaliados 420 pacientes com obesidade mórbida. Amostras de sangue pré e pós-operatório (8 meses após RYGBP) foram obtidas. Os pacientes obesos foram submetidos a RYGBP laparoscópica e após oito meses todos os testes foram repetidos. RESULTADOS: A prevalência de hiperuricemia foi 34,28%. A hiperuricemia foi mais comum em homens do que em mulheres (51,72 vs. 29,72%, p = 0,0002). Homens com hiperuricemia foram mais propensos a ter diabetes (p = 0,034) e tinham níveis mais elevados de glicemia de jejum (p = 0,027). Mulheres com hiperuricemia foram mais propensas a ter hipertensão arterial (p = 0,003), síndrome metabólica (p = 0,001), triglicérides elevado (p = 0,001) e GGT (p = 0,009) e diminuição de HDL (p = 0,011). Após a cirurgia, os níveis de ácido úrico diminuíram de 5,60 ± 1,28 para 4,23 ± 1,20 (p < 0,0001). A prevalência de hiperuricemia diminuiu 33,6% para 6,4% (p < 0,0001), em homens de 48,3% para 17,2% (p < 0,0001) e nas mulheres de 29,7% para 3,6% (p < 0,0001). CONCLUSÃO: As concentrações de ácido úrico foram associadas com a prevalência de anormalidades metabólicas nesta amostra de pacientes com obesidade mórbida. Além disso, a perda de peso após RYGBP pode reduzir os níveis de ácido úrico e a prevalência de hiperuricemia.

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          Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country

          Background The prevalence of hyperuricemia has rarely been investigated in developing countries. The purpose of the present study was to investigate the prevalence of hyperuricemia and the association between uric acid levels and the various cardiovascular risk factors in a developing country with high average blood pressures (the Seychelles, Indian Ocean, population mainly of African origin). Methods This cross-sectional health examination survey was based on a population random sample from the Seychelles. It included 1011 subjects aged 25 to 64 years. Blood pressure (BP), body mass index (BMI), waist circumference, waist-to-hip ratio, total and HDL cholesterol, serum triglycerides and serum uric acid were measured. Data were analyzed using scatterplot smoothing techniques and gender-specific linear regression models. Results The prevalence of a serum uric acid level >420 μmol/L in men was 35.2% and the prevalence of a serum uric acid level >360 μmol/L was 8.7% in women. Serum uric acid was strongly related to serum triglycerides in men as well as in women (r = 0.73 in men and r = 0.59 in women, p < 0.001). Uric acid levels were also significantly associated but to a lesser degree with age, BMI, blood pressure, alcohol and the use of antihypertensive therapy. In a regression model, triglycerides, age, BMI, antihypertensive therapy and alcohol consumption accounted for about 50% (R2) of the serum uric acid variations in men as well as in women. Conclusions This study shows that the prevalence of hyperuricemia can be high in a developing country such as the Seychelles. Besides alcohol consumption and the use of antihypertensive therapy, mainly diuretics, serum uric acid is markedly associated with parameters of the metabolic syndrome, in particular serum triglycerides. Considering the growing incidence of obesity and metabolic syndrome worldwide and the potential link between hyperuricemia and cardiovascular complications, more emphasis should be put on the evolving prevalence of hyperuricemia in developing countries.
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            Serum uric acid and leptin levels in metabolic syndrome: a quandary over the role of uric acid.

            This study investigates the impact of uric acid (UA) on the risk factors associated with metabolic syndrome. In addition, this study explores the relationship between UA and insulin resistance and serum leptin levels in metabolic syndrome. A total of 470 subjects (252 women and 218 men) were recruited from the Department of Health Management at Chang Gung Medical Center (Linkou, Taiwan). Metabolic syndrome was defined using a modified Adult Treatment Panel III (ATP III) definition. The formula for the homeostasis model assessment of insulin resistance (HOMA-IR) is as follows: fasting serum insulin (microU/mL) x fasting plasma glucose (mmol/L)/22.5. Diabetes mellitus was diagnosed in 45 subjects (9.6%); 82 subjects (17.4%) had hypertension. Hyperuricemia was diagnosed in 144 subjects (30.6%). Of these subjects, 115 (63 females and 52 males) (24.5%) were diagnosed as having metabolic syndrome. Patients with hyperuricemia had increased body mass index, waist-to-hip ratio, and triglyceride (Tg) level. The subjects also had lower high-density lipoprotein and greater hypertension. Hormone assays showed an elevation of leptin, immunoreactive insulin (IRI), and HOMA-IR in the hyperuricemia group. Uric acid appeared to be better correlated with Tg, blood pressure (both systolic and diastolic), obesity, immunoreactive insulin, and HOMA-IR. Uric acid did not correlate with leptin or blood glucose levels. Metabolic syndrome and Tg/high-density lipoprotein ratio showed a statistically significant difference in HOMA-IR using 3.8 as a cutoff value. Otherwise, there was no difference in leptin value. In conclusion, serum UA is significantly related to risk factors of metabolic syndrome except for blood glucose. Waist-to-hip ratio and HOMA-IR were statistically different in subjects with and without metabolic syndrome.
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              Mediators of tubuloglomerular feedback regulation of glomerular filtration: ATP and adenosine.

              H Castrop (2006)
              In the juxtaglomerular apparatus of the kidney the loop of Henle gets into close contact to its parent glomerulus. This anatomical link between the tubular system and the vasculature of the afferent and efferent arteriole enables specialized tubular cells, the macula densa (MD) cells, to establish an intra-nephron feedback loop designed to control preglomerular resistance and thereby single nephron glomerular filtration rate. This review focuses on the signalling mechanisms which link salt-sensing MD cells and the regulation of preglomerular resistance, a feedback loop known as tubuloglomerular feedback (TGF). Two purinergic molecules, ATP and adenosine, have emerged over the years as most likely candidates to serve as mediators of TGF. Data will be reviewed supporting a role of either ATP or adenosine as mediators of TGF. In addition, a concept will be discussed that integrates both ATP and adenosine into one signalling cascade that includes (i) release of ATP from MD cells upon increases in tubular salt concentration, (ii) extracellular degradation of ATP to form adenosine, and (iii) adenosine-mediated vasoconstriction of the afferent arteriole.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                abem
                Arquivos Brasileiros de Endocrinologia & Metabologia
                Arq Bras Endocrinol Metab
                Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo )
                1677-9487
                February 2011
                : 55
                : 1
                : 38-45
                Affiliations
                [1 ] Faculdade de Medicina do ABC Brazil
                [2 ] Sociedade Brasileira de Cirurgia Bariátrica e Metabólica Brazil
                Article
                S0004-27302011000100005
                10.1590/S0004-27302011000100005
                9321b1df-94eb-436e-ac5a-56dabca4b0db

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-2730&lng=en
                Categories
                ENDOCRINOLOGY & METABOLISM

                Endocrinology & Diabetes
                Uric acid,metabolic syndrome,bariatric surgery,Ácido úrico,síndrome metabólica,cirurgia bariátrica

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