Skip to content


  • Letter to the Editor
  • Open Access

Letter to editor: The waist circumference-adjusted associations between hyperuricemia and other lifestyle-related diseases: methodological issues in cross-sectional study

  • 1,
  • 2 and
  • 3, 4Email author
Diabetology & Metabolic Syndrome20179:23

  • Received: 25 March 2017
  • Accepted: 8 April 2017
  • Published:


  • Methodological issues
  • Cross-sectional study
  • Prediction

Dear Editor-in-Chief

We studied the article written by Miyagami et al. [1] that published in Diabetology & Metabolic Syndrome journal in February 2017. The aim of this study was the relationship between hyperuricemia and lifestyle-related diseases after adjusting with waist circumference (WC). Finally, the authors of this study concluded that Hyperuricemia is an independent predictor of several lifestyle-related diseases, even after adjusting for age, WC, and lifestyle in both sexes which is closely related with insulin resistance. Hyperuricemia might require greater attention during the prevention of lifestyle-related diseases and future cardiovascular disease [1]. However, although this was an appropriate research and its results were very interesting, some methodological issues should be considered.
  1. 1.

    Miyagami et al. [1] evaluated the predictive performance hyperuricemia on several lifestyle-related diseases in a cross-sectional study, whereas longitudinal researches are necessary for making assumptions in clinical prediction models [2]. In other words, assurance of the temporality assumption presence (the dependent variable has to occur after the independent variable) is essential in the prediction model. Thus, prediction models resulting from cross-sectional designs can be misleading [2, 3].

  2. 2.

    Considering the predictive performance of hyperuricemia on several lifestyle-related diseases is an optimistic interpretation. The internal and external validation of the prediction model must be done through bootstrapping and split-validation, respectively [4].


Therefore, according to the above explanation, it is necessary considering to this point in interpretation of results of this study for readers.


Authors’ contributions

All authors had active participation in preparation of manuscript. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran


  1. Miyagami T, Yokokawa H, Fujibayashi K, Gunji T, Sasabe N, Okumura M, et al. The waist circumference-adjusted associations between hyperuricemia and other lifestyle-related diseases. Diabetol Metab Syndr. 2017;9:11.View ArticlePubMedPubMed CentralGoogle Scholar
  2. Steyerberg E. Clinical prediction models: a practical approach to development, validation, and updating. Berlin: Springer Science & Business Media; 2008.Google Scholar
  3. Pakzad R, Safiri S. Letter to the editor: phosphorus as predictive factor for erectile dysfunction in middle aged men: a cross sectional study in Korea; methodological issues to avoid prediction fallacy. Investig Clin Urol. 2017;58:146–7.View ArticlePubMedPubMed CentralGoogle Scholar
  4. Noto D, Cefalù A, Barbagallo C, Ganci A, Cavera G, Fayer F, et al. Baseline metabolic disturbances and the twenty-five years risk of incident cancer in a Mediterranean population. Nutr Metab Cardiovasc Dis. 2016;26:1020–5.View ArticlePubMedGoogle Scholar


© The Author(s) 2017