Purine-rich foods, protein intake, and the prevalence of hyperuricemia: The Shanghai Men’s Health Study

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Abstract

Background and aims

Diet may play an important role in the development of hyperuricemia and gout. However, the association between dietary factors and hyperuricemia remains unclear, and few studies have investigated direct links between food intake and hyperuricemia. The aim of this study was to investigate associations between high purine-content foods and protein intake with the prevalence of hyperuricemia by using data from a cross-sectional study of 3978 men aged 40–74 yrs living in Shanghai, China.

Methods and Results

Hyperuricemia was defined as blood uric acid level >7.0 mg/dl. One quarter of this population had hyperuricemia. Dietary information was collected by using a food frequency questionnaire. We collected information on anthropometric measurements and lifestyle factors and other potential confounding factors and disease history via interviews. Total protein consumption was not associated with hyperuricemia. We found a positive association between protein from animal sources and prevalence of hyperuricemia and an inverse association between protein from plant sources and hyperuricemia. However, these associations failed to reach significance in mutually adjusted analysis. Seafood intake was associated with higher prevalence of hyperuricemia. The ORs for quintiles of seafood intake (including fish and shellfish) were 1.00, 1.49, 1.35, 1.34, and 1.56 (p for trend: 0.01). An inverse association approaching significance between soy food consumption and hyperuricemia was observed (ORs: 1.00, 0.90, 0.70, 0.89, and 0.77 for quintiles of intake; p for trend: 0.07). No associations between consumption of purine-rich vegetables or meat and prevalence of hyperuricemia were observed.

Conclusions

Our data suggest a direct association between seafood consumption and hyperuricemia and an inverse association between consumption of soy food and hyperuricemia among middle-aged, Chinese men.

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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