HUBUNGAN ANTARA KONSENTRASI ASAM URAT SERUM DENGAN RESISTENSI INSULIN PADA PENDUDUK SUKU BALI ASLI DI DUSUN TENGANAN PEGRINGSINGAN KARANGASEM

Abstract

Elevated serum uric acid concentrations are commonly seen in association with individual cardiovascular risk factor
such as hypertriglyseridemia, hypertension, obesity, and hyperglycemia, a cluster that, when found together in the same person,
characterizes the so-called metabolic syndrome. The original conceptualization of this syndrome was on the basis of resistance to
the actions of insulin. The reduction of endothelial nitric oxide bioavailability and the production of reactive oxygen species by
uric acid may be the mechanism for insulin resistance. Otherwise insulin has a physiological action on renal tubules by stimulating
reabsorption of sodium and urate, resulting an increase in serum uric acid levels. In this condition, HOMA-IR was the model
which is a convenient means of evaluating insulin resistance.
To know the association between serum uric acid concentration and insulin resistance, a cross sectional analytic study
was conducted on Balinese in Tenganan region between Desember 2007 and January 2008. The study involved 80 participants
age of 18-65 years old, agree to participate by informed consent. Serum concentration of insulin was measured by immunoassay
method, plasma glucosa, serum uric acid, HDL-cholesterol, trigycerides, serum creatinin, were determined by enzymatic procedure
after overnight fast. Descriptive statistic analysis on numeric data presented as mean ± SD, nominal and ordinal data in
proportion. Inferential statistic analysis with bivariate KendallÕs tau correlation and simple logistic regression was performed and
multiple logistic regression was used to know the independency of its association.
Of 80 eligible samples, 39 (49%) men, and 41 (51%) women, mean age was 41.73 ± 12.41 yo, mean of waist circumference
was 77.99 ± 10.91 cm, mean of serum uric acid concentration was 5.49 ± 1.38 mg/dL, mean of plasma glucosa was 92.04
± 8.79 mg/dL, median of insulin was 2.70 (2.00 Ð 17.90) mIU/mL, median of HOMA-IR was 0.685 (0.38-4.10), mean of HDL
cholesterol was 59.19 ± 14.01 mg/dL, and median of triglycerides was 122.50 (48 Ð 369) mg/dL. In univariate analysis, the
insulin resistance were positively correlated with serum uric acid, waist circumference, and triglycerides (r= 0.234; P = 0.003),
(r = 0.269; P = 0.001), and (r = 0.153; P = 0.046) respectively and negatively with HDL cholesterol (r = -0.297; P = 0.009). In
multivariate analysis with multiple logistic regression both the 2nd tertile of uric acid (4,7 Ð 6,6 mg/dL) and waist circumference
were independently associated with the insulin resistance (PR 3.97; IK 95% : 1.273 Ð 12.386; P = 0.018), and (PR 5.79; IK 95%
: 1.417 Ð 23.650; P = 0.014) respectively. Conclusion: There is association between serum uric acid concentration and insulin
resistance, and both the 2nd tertile of uric acid and waist circumference are independently and significantly associated with insulin
resistance.