Hiperüriseminin Kas Gücü ve Kütlesi Üzerine Etkisi

Year 2021, Volume: 4 Issue: 1, 1 - 8, 30.04.2021

Esra Ateş Bulut , Suleyman Emre Kocyıgıt , Ali Ekrem Aydın

https://doi.org/10.47141/geriatrik.919495

Abstract

Amaç: Sarkopeni, yaşlı hastalarda istenmeyen sağlık sonuçlarına neden olan yıkıcı bir geriatrik sendromdur. Sarkopeni patofizyolojisinde, yaşlanma süreciyle artan inflamasyon ve oksidatif stresin önemli bir rol oynadığı düşünülmektedir. İnflamatuar etkilerinin yanında antioksidan özelliği olan ürik asitin (ÜA) kas gücü ve kütlesi üzerine etkisi net olarak belirlenememiştir. Bu çalışmada yüksek serum ÜA düzeylerinin sarkopeni ve bileşenleri üzerine etkisinin araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Ocak 2017 ile Ocak 2020 tarihleri arasında geriatri polikliniğine başvuran ayrıntılı geriatrik değerlendirme yapılan hastaların dosya kayıtları incelendi. Hastaların demografik özellikleri, sistemik hastalıkları, laboratuvar değerleri elde edildi. Sarkopeni tanısı Avrupa Sarkopeni Çalışma Grubu (EWGSOP)’nun 2019 yılında revize ettiği tanı kriterlerine göre konuldu. Kas kütlesi biyoimpedans ile değerlendirildi, el kavrama gücü el dinamometresi ile ölçüldü. Katılımcılarda hiperürisemi, serum ÜA düzeyinin erkeklerde >7,0 mg/dL, kadınlarda ise >5,7 mg/dL olması olarak kabul edildi.

Bulgular: Çalışmaya toplam 559 hasta dahil edildi, katılımcıların ortalama yaşı 72,55±7,89 yıl olarak tespit edildi. Katılımcıların %60,2’si kadındı, %20,03’ünde hiperürisemi mevcuttu. Hiperürisemi grubunda diyabetes mellitus ve kronik obstrüktif akciğer hastalığı tanısı daha sıktı. Sarkopeni ve diğer geriatrik sendromlar açısından gruplar arasında anlamlı fark gözlenmedi. Sarkopeni komponentlerinden düşük kas kütlesi, düşük kavrama gücü ve düşük yürüme hızıyla ÜA seviyesi arasında bir ilişki bulunmadı (p>0.05).

Sonuç: İnflamatuar ve antioksidan etkileri olan ÜA’nın sarkopeni ile ilişkisi net değildir. Hiperürisemi için risk faktörü olan obezite, kronik böbrek hastalığı ve kardiyovasküler hastalıkların kontrolü aynı zamanda sarkopeninin engellenmesinde de önem taşımaktadır. Bu aşamada, yaşlı hastalarda ÜA düzeylerinin takip edilmesi ve kronik hastalıkların optimal tedavisinin sağlanması önerilir.

Keywords

ürik asit, sarkopeni, kas gücü, kas kütlesi, yaşlı

Supporting Institution

Bulunmamaktadır.

The Impact of Hyperuricemia on Muscle Strength and Mass

Abstract

Aim: Sarcopenia is a devastating geriatric syndrome that causes adverse health consequences in older patients. Inflammation and oxidative stress that increase with the aging process are suggested to play an important role in the pathophysiology of sarcopenia. In addition to inflammatory effects, uric acid (UA) has antioxidant properties, and the effect of UA on muscle strength and mass has not been clearly determined. In this study, it was aimed to investigate the effect of high serum UA levels on sarcopenia and its components.

Material and Methods: The records of patients who were admitted to the geriatric outpatient clinic between January 2017 and January 2020 and underwent a comprehensive geriatric assessment, was reviewed. Demographic characteristics, systemic diseases, and laboratory values of the patients were obtained. The diagnosis of sarcopenia was made on the basis of the diagnostic criteria revised by the European Sarcopenia Working Group (EWGSOP) in 2019. Muscle mass was evaluated by bioimpedance, and handgrip strength was measured with a hand dynamometer. Hyperuricemia in the participants was accepted as serum uric acid level >7.0mg/dL in men and >5.7 mg/dL in women.

Results: A total of 559 patients were included in the study, and the mean age of the participants was 72.55 ± 7.89 years. 60.2% of the participants were women, 20.03% had hyperuricemia. Diabetes mellitus and chronic obstructive pulmonary disease were more frequent in the hyperuricemia group. There was no significant difference between the groups in terms of sarcopenia and other geriatric syndromes. No relationship was found between low muscle mass, low grip strength, and low walking speed, which are the components of sarcopenia, and UA level (p> 0.05).

Conclusion: The relation of UA, which has inflammatory and antioxidant effects, with sarcopenia is not clear. Control of obesity, chronic kidney disease, and cardiovascular diseases, which are risk factors for hyperuricemia, is also important in preventing sarcopenia. At this stage, it is recommended to monitor UA levels in older patients and provide optimal treatment of chronic diseases.

Keywords

uric acid, sarcopenia, muscle strength, muscle mass, older adults

References

• 1. Dhillon RJ, Hasni S. Pathogenesis and Management of Sarcopenia. Clin Geriatr Med. 2017;33(1):17-26.
• 2. Ates Bulut E, Soysal P, Aydin AE, et al. Vitamin B12 deficiency might be related to sarcopenia in older adults. Exp Gerontol. 2017;95:136-40.
• 3. Fulle S, Protasi F, Di Tano G, et al. The contribution of reactive oxygen species to sarcopenia and muscle ageing. Exp Gerontol. 2004;39(1):17-24.
• 4. Johnson RJ, Segal MS, Srinivas T, et al. Essential hypertension, progressive renal disease, and uric acid: a pathogenetic link? J Am Soc Nephrol. 2005;16(7):1909-19.
• 5. Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. Am J Med. 2007;120(5):442-7.
• 6. Cortese F, Giordano P, Scicchitano P, et al. Uric acid: from a biological advantage to a potential danger. A focus on cardiovascular effects. Vascul Pharmacol. 2019;120:106565.
• 7. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008;359(17):1811-21.
• 8. Tuven B, Soysal P, Unutmaz G, et al. Uric acid may be protective against cognitive impairment in older adults, but only in those without cardiovascular risk factors. Exp Gerontol. 2017;89:15-9.
• 9. Macchi C, Molino-Lova R, Polcaro P, et al. Higher circulating levels of uric acid are prospectively associated with better muscle function in older persons. Mechanisms of Ageing and Development. 2008;129(9):522-7.
• 10. Huang C, Niu K, Kobayashi Y, et al. An inverted J-shaped association of serum uric acid with muscle strength among Japanese adult men: a cross-sectional study. BMC Musculoskeletal Disorders. 2013;14(1):258.
• 11. Kawamoto R, Ninomiya D, Kasai Y, et al. Serum Uric Acid Is Positively Associated with Handgrip Strength among Japanese Community-Dwelling Elderly Women. PloS one. 2016;11(4):e0151044-e.
• 12. Xu Z-R, Zhang Q, Chen L-F, et al. Characteristics of hyperuricemia in older adults in China and possible associations with sarcopenia. Aging medicine (Milton (N.S.W)). 2018;1(1):23-34.
• 13. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC, 2013.
• 14. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.
• 15. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72.
• 16. Cruz-Jentoft AJ, Bahat G, Bauer J. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48.
• 17. Ates Bulut E, Soysal P, Dokuzlar O, et al. Validation of population-based cutoffs for low muscle mass and strength in a population of Turkish elderly adults. Aging Clin Exp Res. 2020.
• 18. Unutmaz GD, Soysal P, Tuven B, et al. Costs of medication in older patients: before and after comprehensive geriatric assessment. Clin Interv Aging. 2018;13:607-13.
• 19. Chen-Xu M, Yokose C, Rai SK, et al. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol. 2019;71(6):991-9.
• 20. Cooper R, Kuh D, Hardy R. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. Bmj. 2010;341:c4467.
• 21. Janssen I, Shepard DS, Katzmarzyk PT, et al. The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc. 2004;52(1):80-5.
• 22. Cirillo P, Sato W, Reungjui S, et al. Uric acid, the metabolic syndrome, and renal disease. J Am Soc Nephrol. 2006;17(12 Suppl 3):S165-8.
• 23. Russell ST, Eley H, Tisdale MJ. Role of reactive oxygen species in protein degradation in murine myotubes induced by proteolysis-inducing factor and angiotensin II. Cell Signal. 2007;19(8):1797-806.
• 24. Kutzing MK, Firestein BL. Altered uric acid levels and disease states. J Pharmacol Exp Ther. 2008;324(1):1-7.
• 25. Wu Y, Zhang D, Pang Z, et al. Association of serum uric acid level with muscle strength and cognitive function among Chinese aged 50-74 years. Geriatr Gerontol Int. 2013;13(3):672-7.
• 26. Beavers KM, Beavers DP, Serra MC, et al. Low relative skeletal muscle mass indicative of sarcopenia is associated with elevations in serum uric acid levels: findings from NHANES III. J Nutr Health Aging. 2009;13(3):177-82.