في مناقشة النتائج تفسر نتائجك في إطار المعرفة الموجودة وتسلط الضوء على المستقبل

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Discussion & Conclusion

Example of Discussion Analysis

Low Urine pH Is Associated with Non-alcoholic Fatty Liver Disease: A Community-based Cross-sectional Study. Miyake et al. Intern Med. 2018 Oct 1; 57(19): 2799–2805.


درس الباحثون العلاقة بين ارتفاع درجة حموضة البول ومرض تكدس الدهون في الكبد لأسباب لا تتعلق بتعاطي الكحول. خلصت الدراسة إلى وجود مثل هذه العلاقة في الرجال والنساء وأن المرض أكثر انتشارا بين الذين لديهم ارتفاع أعلى في حموضة البول. كما وجدت أن العلاقة بين درجة الحموضة وحدوث المرض أقوى في النساء من الرجال وعزت ذلك لأسباب هرمونية


موجز لأهم النتائج واستشهاد بدراسات سابقة تدعمها

In this community-based cross-sectional study, we examined the relationship between low urine pH and NAFLD, with results showing that the NAFLD prevalence increased as urine pH decreased. In addition, urine pH was significantly associated with NAFLD in both sexes. This significant association remained after adjustment for potential metabolic confounders, although the significance in men was lost in a multivariate analysis adjusted for ALT. Furthermore, NAFLD patients with low urine pH had higher ALT levels in both sexes than those with normal urine pH. Our results are supported by those of previous studies that showed a relationship between low urine pH and metabolic disorders, such as a high BMI, abnormal glucose tolerance, and metabolic syndrome, which are associated with NAFL.

شرح لمبرر الدراسة وأهميتها

A urinalysis is a convenient and cheap test routinely conducted at health checkups and in clinical practice on site. Although urine specific gravity, urine glucose, and ketonuria are useful in screening for dehydration, endocrinopathy, kidney disease, and diabetes, the importance of urine pH in metabolic disease has not been elucidated. Several recent studies have demonstrated the association between urine pH and metabolic diseases (,,,). We therefore believe that conducting a simple urinalysis, especially for urine pH, might increase the probability of diagnosing metabolic diseases, including NAFLD. 

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شرح العلاقة التي  درسها البحث على ضوء الأبحاث المنشورة

The association between urine pH and NAFLD might be related to insulin resistance. Abate et al. conducted a study involving 55 healthy volunteers and 13 patients with uric acid nephrolithiasis to examine whether or not insulin resistance is associated with low urine pH using the hyperinsulinemic euglycemic clamp technique, and they reported that insulin resistance contributed to low urine pH (). Maalouf et al. evaluated the association between metabolic diseases and 24-h urine pH in 148 kidney stone-free adults and showed that low 24-h urine pH was associated with HOMA-IR as well as the BMI, fasting glucose, triglycerides, systolic blood pressure, and high-density lipoprotein cholesterol (). In addition, experimental studies have shown that insulin increases the production and activity of the Na+/H+ exchanger in renal tubular cell lines (). In contrast, fatty liver is thought to induce insulin resistance. Patients with fatty liver have elevated levels of hepatokines, such as fetuin-A and selenoprotein P (,). These hepatokines are associated with insulin resistance through the inhibition of insulin-induced tyrosine phosphorylation of the insulin receptor substrate-1 () as well as the inactivation of adenosine monophosphate-activated protein kinase (). Furthermore, fatty liver can impair the ability of insulin to activate glycogen synthase (). Therefore, NAFLD may be associated with low urine pH through the induction of insulin resistance.

شرح أن العلاقة أقوى في النساء من الرجال لأسباب هرمونية استنادا إلى دراسات سابقة

Our results showed that the strength of the association between urine pH and NAFLD was higher in women than in men. This association may be due to hormonal changes related to menopause. Kato et al. found that the urine pH of postmenopausal women was lower than that of premenopausal women (). Furthermore, NAFLD is reported to be twice as common in postmenopausal women as in premenopausal women, and hormonal replacement therapy for postmenopausal women reduces the risk of NAFLD (). Therefore, there may be a strong relationship between low urine pH and NAFLD in women due to estrogen.

شرح لنقاط قوة الدراسة ونقاط ضعفها

The strengths of our study include the use of a large sample size and the analysis by sex. Furthermore, our research population reflects the Japanese regional general population, as our study used data from the annual checkup offered by the local government. In addition, the NAFLD prevalence obtained in this study was similar to that previously reported (,). However, our study had several limitations. First, we measured urine pH using spot urine samples instead of 24-h urine samples. However, previous reports have shown that the pH of a spot urine sample is correlated with that of a 24-h sample (). Second, we used dipstick testing to measure urine pH. However, dipstick test strips are reported to be as reliable as an electrochemical pH meter (). Third, we did not examine the presence of factors that affect urine pH, such as renal tubular acidosis, urinary tract infections, chronic diarrheal illness, primary hyperparathyroidism, chronic respiratory diseases, medications, and diet. Fourth, we did not completely exclude from the study patients who might have had liver diseases. Although we measured HBs-Ag and anti-HCV and asked the subjects about their history of liver disease, we did not completely exclude other etiologies, such as autoimmune hepatitis and primary biliary cirrhosis, of which the patients might have been unaware. Finally, the information regarding the alcohol intake was collected via self-report, so misreporting may have been a source of bias.

خلاصة الدراسة وأهميتها

However, despite these limitations, our study had several important findings. NAFLD was associated with low urine pH in both sexes, and the NAFLD prevalence significantly increased as urine pH decreased. These results might help clinicians conveniently identify patients at high risk of NAFLD.[/read]


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