Purine-rich foods, protein intake, and the prevalence of hyperuricemia: The Shanghai Men’s Health Study
Introduction
Hyperuricemia has been associated with incident insulin resistance [1] and is highly prevalent among individuals with metabolic syndrome [2], [3], [4]. A positive association between plasma uric acid and the incidence of type 2 diabetes has been found in some [5], [6], [7] but not all studies [8]. Thus, identification of factors associated with the occurrence of hyperuricemia should help in the prevention of type 2 diabetes.
Serum uric acid levels are likely to reflect current dietary habits [9]. Uric acid is the end product of purine metabolism, and thus, eating foods rich in purines contributes to total uric acid levels [10]. A high-protein diet typically contains large quantities of purines. However, such diets may have an uricosuric effect (i.e., increase excretion of uric acid in urine), resulting in lower serum acid levels [11], [12]. Although it has been postulated that diet plays an important role in the development of hyperuricemia and gout, data directly linking food intake with hyperuricemia is limited. Meat and seafood have been associated with higher uric acid levels in some studies [13], [14], while dairy intake has been found to decrease plasma uric acid levels [15], [16], [17]. No associations between total protein intake and uric acid [13], [18] have been reported.
The association between dietary factors and hyperuricemia remains unclear [13], [18]. We evaluated associations between the intake of protein and purine-rich foods and the prevalence of hyperuricemia among men who had provided fasting blood samples at baseline; using data collected in the Shanghai Men's Health Study (SMHS), a population-based study of middle-aged men living in urban Shanghai, China.
Section snippets
The Shanghai Men’s Health Study
The Shanghai Men’s Health Study (SMHS) is a population-based cohort study of 61,504 Chinese men who were between 40 and 74 years of age and free of cancer at enrollment and who lived in urban Shanghai, China. Recruitment for the SMHS was initiated in April 2002 and completed in June 2006. A total of 83,058 eligible male residents of eight communities in urban Shanghai were invited to participate by trained interviewers. A total of 61,504 men with no prior history of cancer were enrolled in the
Results
The mean and median for uric acid in the population are 6.36 and 6.10 mg/dl, respectively. The prevalence of hyperuricemia (uric acid >7 mg/dl) in this middle-aged, male population was 25.0% (Table 1). The median uric acid value for the hyperuricemia group was 8.3 mg/dl (Interquartile range 7.4–8.7) and that for the group with no hyperuricemia was 5.7 mg/dl (Interquartile range 5.2–6.3). Participants with hyperuricemia were more likely to have higher BMI and WHR and to drink alcohol, but were
Discussion
In this study of 3978 middle-aged men living in Shanghai, we found that intake of protein from animal sources and seafood was associated with higher prevalence of hyperuricemia, while soy products appeared to decrease hyperuricemia risk. No association between total protein intake and hyperuricemia was observed. The associations of animal protein intake and plant protein intake with hyperuricemia were not independent of each other.
Other studies have reported no association of protein intake
Acknowledgements
RV performed statistical analyses and prepared the manuscript; XYB provided critical assistance with data collection and provided critical review of the manuscript; WYX supervised data collection and provided critical review of the manuscript; TE, QC, MFL and SF provided critical review of the manuscript; WZ and XO designed the study and provided critical review of the manuscript.
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