Uric Acid Is a Risk Indicator for Metabolic Syndrome-related Colorectal Adenoma: Results in a Korean Population Receiving Screening Colonoscopy

Hyo Jin Kim; Jee Eun Kim; Ji Hye Jung; Eun Ran Kim; Sung Noh Hong; Dong Kyung Chang; Hee Jung Son; Poong-Lyul Rhee; Jae J. Kim; Young-Ho Kim

doi:10.4166/kjg.2015.66.4.202

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Kim, Kim, Jung, Kim, Hong, Chang, Son, Rhee, Kim, and Kim: Uric Acid Is a Risk Indicator for Metabolic Syndrome-related Colorectal Adenoma: Results in a Korean Population Receiving Screening Colonoscopy

Original Article

Korean J Gastroenterol 2015;66(4):202-208.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.4.202

Uric Acid Is a Risk Indicator for Metabolic Syndrome-related Colorectal Adenoma: Results in a Korean Population Receiving Screening Colonoscopy

Hyo Jin Kim^1,^*, Jee Eun Kim^2,^*, Ji Hye Jung¹, Eun Ran Kim¹, Sung Noh Hong¹, Dong Kyung Chang¹, Hee Jung Son^1,², Poong-Lyul Rhee¹, Jae J. Kim¹, Young-Ho Kim¹

¹Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea

²Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea

Correspondence to: Young-Ho Kim, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, 81 Irwon-ro, Gangnam- gu, Seoul 06351, Korea. Tel: +82-2-3410-3409, Fax: +82-2-3410-6983, E-mail: younghokim@skku.edu

^* These authors contributed equally to this work as co-first authors of the paper.

Received 13 July 2015 Revised 16 August 2015 Accepted 27 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

An association between serum uric acid and cancer risk has been noted over the past few decades. There is ongoing debate about whether hyperuricemia represents an independent risk factor for colorectal neoplasm. We investigated the association between serum uric acid and prevalence of colorectal adenoma considering numerous confounding factors.

Methods

A cross-sectional study was performed with individuals who underwent a routine health check-up examination, including a screening colonoscopy and blood chemistry. The association between serum uric acid and prevalence of colorectal adenoma was estimated from the results of a logistic regression analysis.

Results

Of the 1,066 participants, 402 had colorectal adenoma (37.7%). In univariate models, the prevalence of colorectal adenoma was higher in participants in the fourth quartile uric acid level, compared to those in the first quartile uric acid level (OR, 1.67; 95% CI, 1.17–2.42; p=0.004). However, no significant association was detected between serum uric acid and prevalence of colorectal adenoma in multiple logistic regression analysis. A number of metabolic syndrome components exhibited a strong association with the prevalence of colorectal adenoma in the multivariate model (OR, 3.46 for highest vs. lowest; 95% CI, 1.30–9.20; p=0.021). Moreover, serum uric acid was strongly associated with metabolic syndrome-associated variables, including waist circumference, fasting blood glucose, systolic blood pressure, diastolic blood pressure, triglyceride, and high-density lipoprotein.

Conclusions

Uric acid is not an independent risk factor for colorectal adenoma but is a risk indicator for metabolic syndrome-re-lated colorectal adenoma.

Keywords: Colorectal neoplasms, Uric acid, Metabolic syndrome X

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Table 1.

Baseline Characteristics of the Study Subjects

Characteristic	Overall (n=1,066)	Normal (n=664)	Adenoma (n=402)
Age (yr)	51.2±1.4	50.4±5.9	52.6±6.5
Male	722 (67.7)	411 (61.9)	311 (77.4)
Current smoker	287 (26.9)	161 (24.2)	126 (31.3)
Current drinker	773 (72.5)	465 (70.0)	308 (76.6)
Family history of colon cancer	13 (1.2)	9 (1.4)	4 (1.0)
Height (cm)	166.7±7.1	166.0±7.3	167.7±6.5
BMI (kg/m²)	23.7±2.2	23.5±2.2	24.0±2.1
Waist circumference (cm)	84.7±7.4	83.9±7.4	52.6±6.5
SBP (mmHg)	121.6±16.9	120.4±16.2	123.7±17.6
DBP (mmHg)	78.2±11.4	77.2±11.3	79.7±11.5
Uric acid (mg/dL)	5.4±1.4	5.2±1.3	5.5±1.4
FBS (mg/dL)	95.4±16.4	94.0±14.4	97.8±19.0
Total cholesterol (mg/dL)	200.6±34.9	198.3±33.5	204.5±36.8
Triglyceride (mg/dL)	119.4±75.4	112.4±67.8	130.9±85.2
LDL (mg/dL)	128.4±32.5	126.2±31.0	131.9±34.6
HDL (mg/dL)	55.0±14.7	55.7±14.8	53.9±14.4
Prevalence of metabolic syndrome	119 (11.2)	55 (8.3)	64 (15.9)

Values are presented as mean±SD or n (%).

SBP, systolic blood pressure; DBP, diastolic blood pressure; FBS, fasting blood glucose.

Table 2.

OR and 95% CI for Colorect al Adenoma by Po otential Risk Factors

Risk factor	Categories				p-value
Sex	Female		Male
Crude OR (95% CI)	1.00		2.10 (1.59–2.79)		<0.001
Age adjusted OR (95% CI)	1.00		2.16 (1.62–2.87)		<0.001
Smoking	Never or ex-smoker		Current smoker
Crude OR (95% CI)	1.00		1.43 (1.08–1.88)		0.012
Age adjusted OR (95% CI)	1.00		1.64 (1.24–2.18)		0.001
Drinking	No-drinking		Current drinking
Crude OR (95% CI)	1.00		1.40 (1.01–1.86)		0.02
Age adjusted OR (95% CI)	1.00		1.55 (1.16–2.08)		0.003
Metabolic syndrome components	≤1 of 5	2 of 5	3 of 5	≥4 of 5
Crude OR (95% CI)	1.00	1.32 (1.26–2.96)	1.93 (1.26–2.96)	4.84 (1.85–12.62)	<0.001
Age adjusted OR (95% CI)	1.00	1.23 (0.90–1.67)	1.82 (1.18–2.80)	4.27 (1.62–11.27)	0.001
SBP (mmHg)	<120	120–130	130–140	>140
Crude OR (95% CI)	1.00	1.00 (0.72–1.38)	1.55 (1.08–2.22)	1.67 (1.17–2.39)	0.006
Age adjusted OR (95% CI)	1.00	0.95 (0.68–1.33)	1.42 (0.98–2.04)	1.40 (0.97–2.03)	0.082
DBP (mmHg)	<70	70–80	80–90	>90
Crude OR (95% CI)	1.00	1.23 (0.86–1.75)	1.33 (0.93–1.89)	2.06 (1.36–3.12)	0.006
Age adjusted OR (95% CI)	1.00	1.26 (0.88–1.80)	1.27 (0.89–1.82)	1.98 (1.31–3.01)	0.014
	Quartiles
	Q1	Q2	Q3	Q4
Height (cm)
Mean	156.5	164.4	169.5	174.7
Crude OR (95% CI)	1.00	1.36 (0.94–1.98)	2.11 (1.46–3.05)	1.81 (1.26–2.59)	<0.001
Age adjusted OR (95% CI)	1.00	1.40 (0.96–2.05)	2.36 (1.62–3.44)	2.20 (1.52–3.20)	<0.001
BMI (kg/m²)
Mean	18.2	21.5	23.9	26.3
Crude OR (95% CI)	1.00	0.91 (0.16–5.03)	1.28 (0.23–7.07)	1.59 (0.29–8.80)	0.006
Age adjusted OR (95% CI)	1.00	0.67 (0.12–3.83)	0.91 (0.16–5.19)	1.16 (0.20–6.64)	0.009
Waist circumference (cm)
Mean	74.6	82.1	86.5	92.8
Crude OR (95% CI)	1.00	1.41 (0.97–2.05)	1.93 (1.31–2.83)	1.87 (1.31–2.68)	0.002
Age adjusted OR (95% CI)	1.00	1.35 (0.92–1.97)	1.81 (1.23–2.67)	1.69 (1.17–2.43)	0.010
Uric acid (mg/dL)
Mean	3.6	4.8	5.8	7.2
Crude OR (95% CI)	1.00	1.20 (0.83–1.74)	1.75 (1.23–2.47)	1.67 (1.17–2.42)	0.004
Age adjusted OR (95% CI)	1.00	1.23 (0.84–1.79)	1.77 (1.24–2.52)	1.81 (1.25–2.62)	0.002
FBS (mg/dL)
Mean	80.5	88.5	95.1	113.6
Crude OR (95% CI)	1.00	0.95 (0.66–1.38)	1.13 (0.78–1.63)	1.59 (1.12–2.26)	0.013
Age adjusted OR (95% CI)	1.00	0.92 (0.63–1.35)	1.05 (0.72–1.52)	1.36 (0.95–1.96)	0.134
Total cholesterol (mg/dL)
Mean	157.5	188.0	209.9	245.5
Crude OR (95% CI)	1.00	1.40 (0.98–2.01)	1.14 (0.79–1.63)	1.68 (1.18–2.40)	0.02
Age adjusted OR (95% CI)	1.00	1.38 (0.96–1.98)	1.12 (0.77–1.62)	1.67 (1.16–2.39)	0.026
Triglyceride (mg/dL)
Mean	55.6	84.4	120.4	214.6
Crude OR (95% CI)	1.00	1.09 (0.75–1.58)	1.75 (1.23–2.51)	2.05 (1.43–2.94)	<0.001
Age adjusted OR (95% CI)	1.00	1.04 (0.72–1.52)	1.62 (1.13–2.33)	2.01 (1.39–2.89)	<0.001
LDL (mg/dL)
Mean	88.2	116.9	136.9	170.5
Crude OR (95% CI)	1.00	0.96 (0.67–1.37)	1.01 (0.71–1.44)	1.40 (0.99–1.98)	0.118
Age adjusted OR (95% CI)	1.00	0.96 (0.67–1.38)	0.97 (0.68–1.40)	1.41 (0.99–2.00)	0.100
HDL (mg/dL)
Mean	37.8	47.9	57.5	74.8
Crude OR (95% CI)	1.00	0.85 (0.60–1.20)	0.73 (0.51–1.04)	0.63 (0.44–0.90)	0.065
Age adjusted OR (95% CI)	1.00	0.83 (0.58–1.19)	0.71 (0.50–1.02)	0.18 (0.45–0.93)	0.092

SBP, systolic blood pressure; DBP, diastolic blood pressure; FBS, fasting blood glucose.

Table 3.

Correlation Coefficients for Baseline Metabolic Syndrome-related Risk Factors with Serum Uric Acid

	BMI (kg/m²)	Waist circumference (cm)	SBP (mmHg)	DBP (mmHg)	FBS (mg/dL)	TC (mg/dL)	TG (mg/dL)	HDL (mg/dL)
Uric acid (mg/dL)	0.436^∗∗∗	0.425^∗∗∗	0.156^∗∗∗	0.294^∗∗∗	0.103^∗∗	0.063^∗	0.299^∗∗∗	−0.351^∗∗∗

SBP, systolic blood pressure; DBP, diastolic blood pressure; FBS, fasting blood glucose; TC, total cholesterol; TG, triglyceride.

^∗ p<0.05

^∗∗ p<0.01

^∗∗∗ p<0.001.

Table 4.

Multivariate Adjusted OR and 95% CI for Colorectal Adenoma

Risk factor	Categories				p-value
Model 1
Triglyceride	Q1	Q2	Q3	Q4
Adjusted OR (95% CI)	1.00	0.91 (0.62–1.34)	1.29 (0.88–1.89)	1.55 (1.06–2.28)	0.02
Model 2
Total cholesterol	Q1	Q2	Q3	Q4
Adjusted OR (95% CI)	1.00	1.34 (0.93–1.94)	1.11 (0.76–1.62)	1.65 (1.15–2.39)	0.036
Metabolic syndrome components	≥1 of 5	2 of 5	3 of 5	≤4 of 5
Adjusted OR (95% CI)	1.00	1.09 (0.79–1.50)	1.58 (1.02–2.45)	3.46 (1.30–9.20)	0.021

Model 1 adjusted for age (continuous), sex, smoking, drinking, and quartiles of height, systolic blood pressure, diastolic blood pressure, BMI, waist circumference, uric acid, fasting blood glucose, total cholesterol (TC), triglyceride, LDL, and HDL.

Model 2 adjusted for age (continuous), sex, smoking, drinking, and quartiles of height, BMI, uric acid, TC, LDL, and the number of metabolic syndrome components.

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