Clin Nutr Res.  2014 Jan;3(1):56-63. 10.7762/cnr.2014.3.1.56.

Comparison of Nutrient Intake and Diet Quality Between Hyperuricemia Subjects and Controls in Korea

• Ryu KA
• Kang HH
• Kim SY
• Yoo MK
• Kim JS
• Lee CH
• Wie GA

• KMID: 2279622
• DOI: http://doi.org/10.7762/cnr.2014.3.1.56

Abstract

Hyperuricemia is associated with metabolic syndrome as well as gout, and the prevalence of hyperuricemia is increasing in Korea. This study aimed to compare the nutrient intake and diet quality between hyperuricemia subjects and controls. Of the 28,589 people who participated in a health examination between 2008 and 2011, 9,010 subjects were selected whose 3-day food records were available. Clinical and laboratory data were collected from electronic medical records. Diet quality was evaluated using the food habit score (FHS), nutrient adequacy ratio (NAR), and mean adequacy ratio (MAR). The prevalence of hyperuricemia was 13.8% (27.1%, men; 5.2%, women). Body mass index, waist circumference, triglycerides, total cholesterol, and low-density lipoprotein cholesterol were significantly higher (p < 0.0001), while high-density cholesterol (p < 0.001) was significantly lower in the hyperuricemia subjects than in the controls. The hyperuricemia subjects had a lower intake of vitamin A (p < 0.004), vitamin C, folate, fiber, and calcium than the controls (p < 0.0001). Intake of vegetables and dairy products was significantly lower, whereas alcohol intake was significantly higher in the hyperuricemia subjects than in the controls ( p < 0.0001). The FHS (p < 0.0001), MAR (p < 0.0001), and NARs for vitamin A (p = 0.01), vitamin B2, vitamin C, folate, and calcium (p < 0.0001) were significantly lower in the hyperuricemia subjects than in the controls. In conclusion, the hyperuricemia subjects reported poorer diet quality than the controls, including higher alcohol intake and lower vegetable and dairy product intake.

Keyword

Hyperuricemia; Uric acid; Diet records; Nutritive Value; Food Habits

MeSH Terms

Ascorbic Acid
Body Mass Index
Calcium
Cholesterol
Dairy Products
Diet Records
Diet*
Electronic Health Records
Folic Acid
Food Habits
Gout
Humans
Hyperuricemia*
Korea*
Lipoproteins
Male
Nutritive Value
Prevalence
Riboflavin
Triglycerides
Uric Acid
Vegetables
Vitamin A
Waist Circumference
Ascorbic Acid
Calcium
Cholesterol
Folic Acid
Lipoproteins
Riboflavin
Triglycerides
Uric Acid
Vitamin A

Figure

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  Figure 1 Inclusion and exclusion criteria for the study subjects. *Visitors for health examination survey from January 1, 2008 to December 31, 2011; †Hyperuricemia was defined as serum uric acid concentration ≥7 mg/dL in men, and ≥6 mg/dL in women [16].

Reference

1. Puig JG, Martínez MA, Mora M, Fraile JM, Montoya F, Torres RJ. Serum urate, metabolic syndrome, and cardiovascular risk factors. A population-based study. Nucleosides Nucleotides Nucleic Acids. 2008; 27:620–623.

2. Zgaga L, Theodoratou E, Kyle J, Farrington SM, Agakov F, Tenesa A, Walker M, McNeill G, Wright AF, Rudan I, Dunlop MG, Campbell H. The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study. PLoS One. 2012; 7:e38123.

3. Fang J, Alderman MH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey. JAMA. 2000; 283:2404–2410.

4. Fessel WJ. High uric acid as an indicator of cardiovascular disease. Independence from obesity. Am J Med. 1980; 68:401–404.

5. Chien KL, Chen MF, Hsu HC, Chang WT, Su TC, Lee YT, Hu FB. Plasma uric acid and the risk of type 2 diabetes in a Chinese community. Clin Chem. 2008; 54:310–316.

6. Heinig M, Johnson RJ. Role of uric acid in hypertension, renal disease, and metabolic syndrome. Cleve Clin J Med. 2006; 73:1059–1064.

7. Burack RC, Keller JB, Higgins MW. Cardiovascular risk factors and obesity: are baseline levels of blood pressure, glucose, cholesterol and uric acid elevated prior to weight gain? J Chronic Dis. 1985; 38:865–872.

8. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008; 359:1811–1821.

9. de Oliveira EP, Burini RC. High plasma uric acid concentration: causes and consequences. Diabetol Metab Syndr. 2012; 4:12.

10. Lee KH, Lee SK. Pathophysiology of gout. Korean J Med. 2011; 80:251–254.

11. Emmerson BT. The management of gout. N Engl J Med. 1996; 334:445–451.

12. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004; 350:1093–1103.

13. Hong SJ, Kim YS, Kim HS. Prevalence and clinical features of hyperuricemia in Gwangju and Jeonnam territories. J Rheum Dis. 2012; 19:138–146.

14. Kim YB, Jhang WG, Hwangbo Y, Kim HS, Ahn KD, Lee BK, Lee YJ, Lee JE, Lee JS, Lss CG, Lee HJ, Lee SS. Risk factors of hyperuricemia in the citizens of Asan. J Soonchunhyang Med Coll. 2006; 12:41–49.

15. Kim EH, Jeon K, Park KW, Kim HJ, Ahn JK, Jeon CH, Cha HS, Koh EM. The prevalence of gout among hyperuricemic population. J Korean Rheum Assoc. 2004; 11:7–13.

16. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology. 3th ed. St. Louis (MO): Mosby;2003.

17. The Korean Nutrition Society. Dietary reference intakes for Koreans 2010. Seoul: The Korean Nutrition Society;2010.

18. Poletto J, Harima HA, Ferreira SR, Gimeno SG. Hyperuricemia and associated factors: a cross-sectional study of Japanese-Brazilians. Cad Saude Publica. 2011; 27:369–378.

19. Choi HK, Atkinson K, Karlson EW, Curhan G. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med. 2005; 165:742–748.

20. Lottmann K, Chen X, Schädlich PK. Association between gout and all-cause as well as cardiovascular mortality: a systematic review. Curr Rheumatol Rep. 2012; 14:195–203.

21. VučZak J, Katić M, Bielen I, Vrdoljak D, Lalić DI, Kranjčević K, Marković BB. Association between hyperuricemia, prediabetes, and prehypertension in the Croatian adult population--a cross-sectional study. BMC Cardiovasc Disord. 2012; 12:117.

22. Torralba KD, De Jesus E, Rachabattula S. The interplay between diet, urate transporters and the risk for gout and hyperuricemia: current and future directions. Int J Rheum Dis. 2012; 15:499–506.

23. Kang DH. Does hyperuricemia play a causative role in the development and/or aggravation of renal, cardiovascular and metabolic disease? Korean J Med. 2011; 80:524–528.

24. Chin HJ, Na KY, Kim Y, Chae DW, Kim S. The impact of uric acid and metabolic syndrome on the incidence of hypertention in a Korean population. Korean J Med. 2007; 73:58–66.

25. Nakagawa T, Hu H, Zharikov S, Tuttle KR, Short RA, Glushakova O, Ouyang X, Feig DI, Block ER, Herrera-Acosta J, Patel JM, Johnson RJ. A causal role for uric acid in fructose-induced metabolic syndrome. Am J Physiol Renal Physiol. 2006; 290:F625–F631.

26. Sánchez-Lozada LG, Tapia E, Bautista-García P, Soto V, Avila-Casado C, Vega-Campos IP, Nakagawa T, Zhao L, Franco M, Johnson RJ. Effects of febuxostat on metabolic and renal alterations in rats with fructose-induced metabolic syndrome. Am J Physiol Renal Physiol. 2008; 294:F710–F718.

27. Schlesinger N. Dietary factors and hyperuricaemia. Curr Pharm Des. 2005; 11:4133–4138.

28. Choi HK, Gao X, Curhan G. Vitamin C intake and the risk of gout in men: a prospective study. Arch Intern Med. 2009; 169:502–507.

29. Sutton JL, Basu TK, Dickerson JW. Effect of large doses of ascorbic acid in man on some nitrogenous components of urine. Hum Nutr Appl Nutr. 1983; 37:136–140.

30. Ghadirian P, Shatenstein B, Verdy M, Hamet P. The influence of dairy products on plasma uric acid in women. Eur J Epidemiol. 1995; 11:275–281.

31. Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005; 52:283–289.

32. Wang Y, Yan S, Li C, Zhao S, Lv J, Wang F, Meng D, Han L, Wang Y, Miao Z. Risk factors for gout developed from hyperuricemia in China: a five-year prospective cohort study. Rheumatol Int. 2013; 33:705–710.

33. Luk AJ, Simkin PA. Epidemiology of hyperuricemia and gout. Am J Manag Care. 2005; 11:S435–S442.

34. Choi HK, Mount DB, Reginato AM. American College of Physicians. American Physiological Society. Pathogenesis of gout. Ann Intern Med. 2005; 143:499–516.

35. Nicklas TA, O'Neil CE, Fulgoni VL 3rd. Diet quality is inversely related to cardiovascular risk factors in adults. J Nutr. 2012; 142:2112–2118.

36. Lim SY, Yoo HJ, Kim AL, Oh JA, Kim HS, Choi YH, Cho JH, Lee JH, Yoon KH. Nutritional intake of pregnant women with gestational diabetes or type 2 diabetes mellitus. Clin Nutr Res. 2013; 2:81–90.

37. Drewnowski A, Fiddler EC, Dauchet L, Galan P, Hercberg S. Diet quality measures and cardiovascular risk factors in France: applying the Healthy Eating Index to the SU.VI.MAX study. J Am Coll Nutr. 2009; 28:22–29.