Gout and fatty liver: A chain of health crises triggered by metabolic disorders

Other Common Chronic Diseases

Chronic non-infectious chronic diseases (NCDs) are characterized by insidious onset, long course, and persistent symptoms. "Non-infectious" refers to the lack of clear evidence of an infectious biological cause; their etiologies are often complex and unclear. It is not a specific disease but a general term encompassing a group of diseases. Common chronic diseases include cardiovascular and cerebrovascular diseases (coronary heart disease, hypertension, stroke, etc.), diabetes, chronic obstructive pulmonary disease (COPD), and malignant tumors. Chronic disease is a long-term disease state characterized by a gradual or progressive decline in organ function. The incidence of chronic diseases increases with age, with the elderly being a high-risk group. In recent years, the trend of chronic diseases affecting younger people has become increasingly apparent. The main harm of chronic diseases is damage to vital organs such as the brain, heart, and kidneys, easily leading to disability, affecting work capacity and quality of life, and incurring extremely high medical costs, increasing the economic burden on society and families.

Gout

Gout is perhaps the oldest "disease of affluence," and it once had a very "prestigious" name. The essence of gout is hyperuricemia. Uric acid production is closely related to purines. In a normal human body, about 20% of purines are ingested from food, and 80% are synthesized by the body itself. Purines are metabolized by the liver to form uric acid, which is mostly filtered and excreted by the glomeruli, with a small portion excreted in feces. The human body has approximately 1200 mg of uric acid, with about 800 mg newly generated and 800 mg excreted daily, maintaining a balance. If too much uric acid is produced and cannot be excreted, or if the uric acid excretion function deteriorates, causing excessive uric acid retention and elevated blood uric acid levels, this is called hyperuricemia. Internationally, hyperuricemia (HUA) is defined as: under normal purine diet conditions, two separate fasting blood uric acid levels > 420 umol/L. Gout can be controlled, but it cannot be cured. The natural course of gout can be divided into the following stages: • Asymptomatic hyperuricemia stage; • Acute gouty arthritis attack stage: joint redness, swelling, heat, and pain accompanied by elevated uric acid; • Intermittent attack stage: uric acid remains high, joint redness, swelling, and pain are temporarily relieved, but recurrence is common; • Chronic tophi stage: gout attacks are relatively less frequent, and subcutaneous tophi are deposited; • Kidney disease stage: renal insufficiency occurs. Modern research shows that hyperuricemia is associated with various diseases, such as hypertension, hyperlipidemia, and diabetes, posing a significant threat to health. Although patients may not yet exhibit clinical symptoms of joint redness, swelling, and burning pain, the harm is potential and ongoing.

1. Hyperuricemia and Gout: Uric acid accumulates in the joint cavity, forming urate crystals that irritate the joints, causing an inflammatory reaction with redness, swelling, heat, and pain, leading to recurrent gout attacks.

2. Hyperuricemia and Kidney Disease: Under normal circumstances, 70% of uric acid in the body is filtered and excreted by the glomeruli. Excessive uric acid in the body, exceeding the glomerular filtration capacity, accumulates in the kidneys and crystallizes, leading to acute hyperuricemic nephropathy, chronic uric acid nephropathy, and even kidney failure. Decreased kidney function further reduces uric acid excretion, exacerbating hyperuricemia.

3. Hyperuricemia and Diabetes: Studies show that for every 60 umol/L increase in uric acid levels in normal individuals, the risk of developing diabetes increases by 17%. Hyperuricemia is also associated with diabetic peripheral neuropathy.

4. Hyperuricemia and Cardiovascular and Cerebrovascular Diseases: Hyperuricemia is often accompanied by metabolic disorders such as hypertension, obesity, hyperlipidemia, and diabetes, easily causing atherosclerosis and ultimately leading to coronary heart disease and stroke.

Fatty Liver

Fatty liver refers to a clinicopathological syndrome characterized by diffuse macrovesicular steatosis in hepatocytes, resulting from one or more etiologies leading to an imbalance in the liver's dynamic homeostasis and lipid metabolism disorders. In traditional Chinese medicine, fatty liver is called "liver obstruction" and mainly includes alcoholic fatty liver and non-alcoholic fatty liver. The main causative factor of alcoholic fatty liver is alcohol. Ethanol is broken down into acetaldehyde by alcohol dehydrogenase in the liver. Acetaldehyde damages the mitochondria and microtubules of hepatocytes, affecting lipid metabolism and thus causing the disease. Simultaneously, endotoxemia caused by ethanol may be related to the pathogenesis of alcoholic fatty liver. Non-alcoholic fatty liver disease is divided into primary and secondary types. Primary non-alcoholic fatty liver disease is related to insulin resistance (IR) and genetic susceptibility, characterized by hepatocyte steatosis and fat accumulation, but without a history of excessive alcohol consumption. Secondary non-alcoholic fatty liver disease may be accompanied by certain specific causes or diseases, such as abnormal nutritional intake, drugs, toxins, and malignant tumors. The fat content of a normal human liver accounts for 3% to 5% of its weight. Fatty liver disease is defined as liver fat exceeding 5% of its weight or histologically, steatosis affecting more than 30% of hepatocytes. Its pathogenesis is related to factors such as malnutrition, medications, metabolism, genetics, and environment. While previously more common in Western countries, its prevalence in my country has been increasing in recent years due to improved living standards and changes in lifestyle and dietary structure. Currently, the prevalence of non-alcoholic fatty liver disease (NAFLD) in Asia is approximately 12%–24%, and it is showing a trend towards affecting younger individuals. Fatty liver is a pathological condition caused by steatosis resulting from multiple factors. The incidence of fatty liver is statistically correlated with factors such as overweight, hypertension, hyperlipidemia, and diabetes. Statistical studies have shown that the prevalence of fatty liver increases with age, and is higher in men than women. Overweight, obese individuals, those with hypertension, high blood sugar, and dyslipidemia have a higher risk of developing fatty liver than those with normal blood lipid levels. The main pathogenic factors of fatty liver can be roughly divided into the following six aspects:

5. Alcohol consumption: Long-term heavy drinkers are most prone to developing alcoholic fatty liver;

6. Obesity and overweight: Individuals with a BMI exceeding the normal range have excessive fat in their livers, increasing the burden on the liver, reducing metabolic rate, and worsening the degree of fatty liver;

7. Hyperglycemia: Most scholars believe that insulin resistance plays a key role in liver fat accumulation. Fatty liver and insulin resistance (IR) share a common etiological basis;

8. Hypertension: Some foreign researchers have pointed out that cases of normal liver enzymes but detectable fatty liver on abdominal ultrasound are common in patients with arteriosclerotic hypertension, because IR is an important prognostic factor for hypertensive patients;

9. Hyperlipidemia: Abnormal blood lipids can lead to excessive fat accumulation in the liver, resulting in fatty liver. Studies have shown that hyperlipidemia plays a significant role in the development of fatty liver, with elevated triglycerides being more pronounced, often accompanied by elevated total cholesterol.

10. Other factors: These include age, gender, and stress. Men have the highest prevalence of fatty liver in the 35-44 age group, with the prevalence gradually decreasing with age. Conversely, women show an increasing prevalence with age. This is because men in this age group tend to have more social activities and drink more alcohol, while their calorie expenditure gradually decreases, leading to the conversion of excess calories into fat and storage in the body, resulting in fatty liver.