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BMI, diet, alcohol use significantly drive hyperuricemia cases
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Maintaining a healthy BMI, adherence to the Dietary Approaches to Stop Hypertension, or DASH, diet, and reductions in alcohol and diuretic use may significantly decrease the frequency of hyperuricemia and the subsequent development of gout, according to data published in Arthritis & Rheumatology.
“While modifiable risk factors for hyperuricemia, the root cause of gout, had been identified, we did not know what proportion of hyperuricemia cases in the U.S. could be prevented by modifying them,” Hyon K. Choi, MD, DrPH, from Massachusetts General Hospital and Harvard Medical School, told Healio Rheumatology. “This was a nationally representative U.S. study where serum uric acid levels were measured prospectively. We found that four modifiable risk factors — BMI, the DASH diet, alcohol use and diuretic use — could individually account for a substantial proportion of hyperuricemia cases.”
They added, “This supports the hypothesis that the majority of U.S. hyperuricemia and resulting gout cases could be prevented by modifying key risk factors.”
To analyze modifiable risk factors related to hyperuricemia, and estimate the proportion of cases that may be prevented through risk modification in the general population, compared with estimates of the variance explained, Choi and colleagues studied data from the National Health and Nutrition Examination Survey (NHANES) III. The researchers limited their scope to 14,624 noninstitutionalized adults aged 20 years and older who underwent medical examination with available information on target risk factors and covariates.
Choi and colleagues calculated adjusted prevalence ratios for hyperuricemia, population attributable risks and the variance explained based on a BMI of 25 kg/m2 or greater, alcohol intake, nonadherence to a DASHstyle diet and diuretic use. They later repeated their analysis among 14,187 NHANES III participants after excluding those with self-reported gout, as well as those taking allopurinol or uricosuric agents.
According to the researchers, BMI, alcohol intake, adherence to a DASHstyle diet and diuretic use were each associated with serum urate levels and hyperuricemia in a doseresponse manner. The corresponding population attributable risk of hyperuricemia cases for obesity was 44% (95% CI, 41-48), 9% (95% CI, 3-16) for DASH nonadherence, 8% (95% CI, 5-11) for alcohol use, and 12% (95% CI, 11-14) for diuretic use. The corresponding variances explained were 8.9%, 0.1%, 0.5%, and 5% respectively.
The researchers also wrote that their simulation study demonstrated the variance nearing zero with exposure prevalence's nearing 100%.
“Patients with an elevated risk of developing gout — for example, those with a family history of gout — should be encouraged to reduce their risk of hyperuricemia, and eventually gout, through weight control, following a healthy diet, and reducing their alcohol intake — changes that also confer cardiovascular benefits,” Choi said. “However, most patients who are already experiencing frequent gout flares will need medications to lower uric acid levels, in addition to managing these risk factors.” – by Jason Laday
Disclosure: The researchers report funding from the NIH.
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