European Journal of Cardiovascular Medicine

Metabolic Syndrome (Mets) is a complex condition characterized by a constellation of interconnected physiological, biochemical, and metabolic abnormalities. These include abdominal obesity, insulin resistance, elevated arterial blood pressure, and dyslipidaemia, which together increase the risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus(T2DM) [1,2].

The prevalence of Metabolic syndrome has been on the rise globally, with nearly one-fourth of the global population now affected by this condition [3] . In India the increasing prevalence of Mets is driven by rapid socioeconomic changes, urbanization, and shifts towards sedentary lifestyles. Recent studies indicate that up to half of the population in large Indian cities may meet the diagnostic criteria for Metabolic syndrome with reported prevalence rates ranging from 11% to 56% [4,5].

Ferritin, a key protein in iron regulation, plays an important role in various physiological functions and is commonly used as a biomarker to assess iron status, especially for diagnosing iron deficiency. Recent studies have linked high ferritin levels to metabolic disorders such as obesity, insulin resistance, Metabolic syndrome and T2DM [6]. Elevated ferritin is particularly associated with insulin resistance, a core feature of Mets. Iron-induced oxidative stress may contribute to tissue damage and inflammation in these cases [7]. Understanding ferritin’s role in metabolic disorders could help identify new treatment strategies for Mets.

Uric acid, a byproduct of purine metabolism, is now recognized as a biomarker linked to metabolic disorders. Hyperuricemia is associated with Metabolic syndrome and T2DM and may contribute to their development, not just result from insulin resistance [8]. Although it has antioxidant effects. uric acid can promote oxidative stress and inflammation in metabolic conditions. This highlights its potential as a therapeutic target for metabolic disorders [9].

This study aims to evaluate serum uric acid and ferritin levels in Mets patients with and without diabetes, exploring their utility as predictors of disease severity

The present study was designed as a cross-sectional, observational study conducted in the Department of General Medicine at ESIC Model Hospital, Jaipur. A total of 110 patients fulfilling the International Diabetes Federation (IDF) criteria for metabolic syndrome were enrolled, of which 45 had type 2 diabetes mellitus and 65 did not. Patients with chronic kidney disease, gout, thyroid dysfunction, malignancy, anaemia (haemoglobin <10 g/dL), active infection, or those on uric acid or iron supplementation were excluded. Data collection included anthropometric measurements such as body mass index (BMI) and waist circumference, along with blood pressure assessment using a standardised sphygmomanometer. Biochemical investigations were performed, including serum uric acid estimation by enzymatic method, serum ferritin using chemiluminescence immunoassay, lipid profile, fasting blood sugar, and glycated haemoglobin (HbA1c). Statistical analysis was carried out using SPSS version 24, applying independent t-tests for continuous variables and chi-square tests for categorical variables, with a p-value of <0.05 considered statistically significant

The study population had a mean age of 46.5 years, with a female predominance (57.3%) compared to males (42.7%). Serum uric acid levels were found to be significantly higher in diabetic patients (6.97 ± 0.92 mg/dL) compared to non-diabetic patients (4.18 ± 0.77 mg/dL, p < 0.0001). Similarly, serum ferritin concentrations were markedly elevated in diabetics (330.84 ± 596.31 ng/mL) relative to non-diabetics (213.54 ± 369.06 ng/mL, p < 0.0001). Correlation analysis revealed that uric acid and ferritin were positively associated with triglyceride and LDL levels, while showing a negative association with HDL cholesterol, further supporting their role in metabolic syndrome.

Graph 1: Comparison of uric acid, ferritin, and lipid markers in diabetic vs. non-diabetic Mets patients.

Scatter Diagram 1 Correlation between Uric Acid and Triglycerides

Scatter Diagram 2: Correlation between Triglycerides and ferritin

This study evaluated the association of serum uric acid and ferritin levels with metabolic syndrome (Mets), comparing patients with and without type 2 diabetes mellitus (T2DM). The results demonstrated that diabetic Mets patients had significantly higher mean serum uric acid and ferritin levels than their non-diabetic counterparts. These findings highlight the potential role of these biomarkers as indicators of metabolic severity and cardiovascular risk.

Our results on uric acid are in line with the observations of Bonakdaran et al. (2014) (10), who reported a strong association between elevated serum uric acid and metabolic syndrome in diabetic patients. They demonstrated that higher uric acid levels correlated positively with cholesterol and triglycerides, while negatively with HDL cholesterol, reinforcing the role of hyperuricemia as a marker of atherogenic dyslipidaemia. Similarly, the current study found that uric acid was significantly elevated in diabetic patients and positively associated with triglycerides and LDL levels.

The prevalence of hyperuricemia in diabetic patients has been well established in recent studies. Sun et al. (2023) (11) reported that approximately 21% of diabetic patients exhibited hyperuricemia, with a higher prevalence among males. They further highlighted the association between hyperuricemia, obesity, and elevated triglycerides. Similarly, Woyesa SB et al (2017) (12) reported high prevalence of hyperuricemia and metabolic syndrome in type 2 diabetes mellitus. The study also revealed a significant positive correlation between hyperuricemia and elevated triglyceride level as well as reduced HDL-C levels in these patients. The finding of these studies aligns with our results, where diabetic Mets patients demonstrated higher uric acid levels along with adverse lipid profiles, supporting the hypothesis that uric acid exacerbates insulin resistance and dyslipidaemia in this population.

Ferritin levels were also significantly elevated in diabetic Mets patients in our cohort. This finding concurs with Padwal et al. (2015) (6), who showed that serum ferritin is strongly associated with insulin resistance and higher HOMA-IR scores among Mets patients. They suggested that elevated ferritin reflects increased iron stores and oxidative stress, which impair insulin signalling. The elevated ferritin values observed in our diabetic subgroup are consistent with this mechanism, indicating that iron overload may contribute to the worsening of metabolic disturbances.

Li et al. (2023) (13) demonstrated a strong association between serum ferritin concentrations and dyslipidaemia in American adults, with particularly pronounced effects in women. Their results support the notion that ferritin contributes to atherogenic lipid changes, which was similarly observed in our study where elevated ferritin correlated with increased triglyceride and LDL levels. These findings suggest that ferritin acts not only as a marker of iron stores but also as a surrogate of inflammation and lipid derangements in metabolic disorders.

Shrivastav SK et al. (2022) (14) observed that ferritin levels were strongly positively associated with increased cholesterol, LDL and triglyceride level and negatively associated with HDL levels. Our finding are consistent with their study.

Taken together, the elevated serum uric acid and ferritin levels observed in diabetic Mets patients underscore their clinical importance as biomarkers of metabolic derangements. Uric acid likely contributes to disease progression through endothelial dysfunction and pro-inflammatory pathways, while ferritin may exert its effects through oxidative stress and impaired insulin signalling. Both markers appear to synergistically amplify metabolic and cardiovascular risks in diabetic Mets patients.

From a clinical perspective, the routine assessment of serum uric acid and ferritin in patients with metabolic syndrome may provide a cost-effective strategy for identifying high-risk individuals, particularly those with coexisting diabetes. Early recognition of elevated levels could allow for timely interventions, such as lifestyle modification, dietary adjustments, and pharmacological strategies targeting hyperuricemia and iron overload. Moreover, incorporating these biomarkers into risk stratification models could help physicians better monitor disease progression and tailor.

Serum uric acid and ferritin are significantly elevated in diabetic Metabolic syndrome patients, correlating with adverse lipid profiles. These markers may serve as predictive tools for disease severity and cardiovascular risk in Metabolic syndrome. Our findings highlight uric acid and ferritin as significant biomarkers differentiating diabetic and non-diabetic Metabolic syndrome patients.

Conflict of interest

There are no conflicts of interest. Financial support and sponsorship Nil

Acknowledgement

We are grateful to all participants who took part in the study and sincerely appreciate their full cooperation.

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