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      Association between smoking behavior and serum uric acid among the adults: Findings from a national cross-sectional study

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          Abstract

          Background

          Gout incidence is increasing worldwide; appropriate management of serum uric acid levels and a healthy lifestyle may help its prevention. The popularity of electronic cigarettes and the resultant emergence of dual smokers is increasing. Despite many studies on the effects of various health behaviors on serum uric acid levels, the association between smoking and serum uric acid levels remains controversial. This study aimed to investigate the association between smoking and serum uric acid levels.

          Methods

          In this study, total sample of 27,013 participants (11,924 men and 15,089 women) were analyzed. This study used data from the Korea National Health and Nutrition Examination Survey (2016–2020) and grouped adults into dual smokers, single smokers, ex-smokers, and non-smokers. Multiple logistic regression analyses were performed to investigate the association between smoking behavior and serum uric acid levels.

          Results

          Compared to male non-smokers, male dual smokers had significantly higher serum uric acid level (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.08–1.88). In female, serum uric acid level was higher among single smokers than non-smokers (OR, 1.68; 95% CI, 1.25–2.25). Higher serum uric acid levels were more likely to be present in male dual smokers with a > 20 pack-year smoking habit (OR, 1.84; 95% CI, 1.06–3.18).

          Conclusion

          Dual smoking may contribute to high serum uric acid levels in adults. Thus, serum uric acid levels should be properly managed through smoking cessation.

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          Most cited references36

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          Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report

          New England Journal of Medicine
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            Global epidemiology of gout: prevalence, incidence and risk factors.

            Gout is a crystal-deposition disease that results from chronic elevation of uric acid levels above the saturation point for monosodium urate (MSU) crystal formation. Initial presentation is mainly severely painful episodes of peripheral joint synovitis (acute self-limiting 'attacks') but joint damage and deformity, chronic usage-related pain and subcutaneous tophus deposition can eventually develop. The global burden of gout is substantial and seems to be increasing in many parts of the world over the past 50 years. However, methodological differences impair the comparison of gout epidemiology between countries. In this comprehensive Review, data from epidemiological studies from diverse regions of the world are synthesized to depict the geographic variation in gout prevalence and incidence. Key advances in the understanding of factors associated with increased risk of gout are also summarized. The collected data indicate that the distribution of gout is uneven across the globe, with prevalence being highest in Pacific countries. Developed countries tend to have a higher burden of gout than developing countries, and seem to have increasing prevalence and incidence of the disease. Some ethnic groups are particularly susceptible to gout, supporting the importance of genetic predisposition. Socioeconomic and dietary factors, as well as comorbidities and medications that can influence uric acid levels and/or facilitate MSU crystal formation, are also important in determining the risk of developing clinically evident gout.
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              Uric acid as a danger signal in gout and its comorbidities.

              Uric acid is a waste product of purine catabolism. This molecule comes to clinical attention when it nucleates to form crystals of monosodium urate (MSU) in joints or other tissues, and thereby causes the inflammatory disease of gout. Patients with gout frequently suffer from a number of comorbid conditions including hypertension, diabetes mellitus and cardiovascular disease. Why MSU crystals trigger inflammation and are associated with comorbidities of gout has been unclear, but recent studies provide new insights into these issues. Rather than simply being a waste product, uric acid could serve a pathophysiological role as a local alarm signal that alerts the immune system to cell injury and helps to trigger both innate and adaptive immune responses. The inflammatory component of these immune responses is caused when urate crystals trigger both inflammasome-dependent and independent pathways to generate the proinflammatory cytokine IL-1. The resulting bioactive IL-1 stimulates the inflammation of gout and might contribute to the development of other comorbidities. Surprisingly, the same mechanisms underlie the inflammatory response to a number of irritant particles, many of which also cause disease. These new insights help to explain the pathogenesis of gout and point to potential new therapeutic targets for this and other sterile inflammatory diseases.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2 May 2023
                2023
                : 18
                : 5
                : e0285080
                Affiliations
                [1 ] Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
                [2 ] Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
                [3 ] Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
                Shahid Beheshti University of Medical Sciences, ISLAMIC REPUBLIC OF IRAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-2306-5398
                Article
                PONE-D-23-02295
                10.1371/journal.pone.0285080
                10153749
                37130102
                f1cf2162-a34b-45ba-adc2-823a397de10c
                © 2023 Jang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 January 2023
                : 16 April 2023
                Page count
                Figures: 1, Tables: 3, Pages: 12
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Psychology
                Behavior
                Habits
                Smoking Habits
                Social Sciences
                Psychology
                Behavior
                Habits
                Smoking Habits
                Biology and Life Sciences
                Psychology
                Addiction
                Nicotine Addiction
                Electronic Cigarettes
                Social Sciences
                Psychology
                Addiction
                Nicotine Addiction
                Electronic Cigarettes
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Nicotine Addiction
                Electronic Cigarettes
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Nicotine Addiction
                Electronic Cigarettes
                Biology and Life Sciences
                Psychology
                Behavior
                Habits
                Smoking Habits
                Electronic Cigarettes
                Social Sciences
                Psychology
                Behavior
                Habits
                Smoking Habits
                Electronic Cigarettes
                Physical Sciences
                Chemistry
                Chemical Compounds
                Acids
                Uric Acid
                Biology and Life Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Medicine and Health Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Medicine and Health Sciences
                Medical Conditions
                Inflammatory Diseases
                Gout
                Medicine and Health Sciences
                Rheumatology
                Gout
                Medicine and Health Sciences
                Medical Conditions
                Metabolic Disorders
                Dyslipidemia
                Medicine and Health Sciences
                Medical Conditions
                Cardiovascular Diseases
                Cardiovascular Disease Risk
                Medicine and Health Sciences
                Cardiology
                Cardiovascular Medicine
                Cardiovascular Diseases
                Cardiovascular Disease Risk
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                Custom metadata
                The data of KNHANES is publicly available throuth the website ( https://knhanes.kdca.go.kr/knhanes/main.do).

                Uncategorized
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