The Epidemiology of Uric Acid and Fructose
Section snippets
Epidemiology of Uric Acid
According to the Third US National Health and Nutritional Examination Survey (NHANES III, 1988-1994) study (Table 1), the estimated mean serum uric acid concentration of the US population was 5.33 mg/dL (95% confidence interval [CI], 5.29-5.37 mg/dL). Overall, men had higher serum concentrations (6.06 mg/dL) than women (4.66 mg/dL) by approximately 1.4 mg/dL. The mean serum uric acid concentrations did not appear to differ significantly across race/ethnicity in this nationally representative
Demographics
Although hyperuricemia and gout historically have been considered conditions of men, and most research has focused on men, growing evidence suggests a substantial disease burden of gout among older women.14, 38 The difference in serum uric acid levels between the sexes10 likely is owing to the increased renal urate clearance by estrogen in women, particularly before menopause.39 A Japanese study showed a combination of estrogen and progesterone resulting in a significant decrease in serum uric
Trends in Fructose Consumption
The consumption of fructose in the United States has increased considerably since the introduction of high fructose corn syrup (HFCS) in 1967.25 HFCS is a product made from corn, and usually has a composition of 42% fructose (HFCS-42) or 55% fructose (HFCS-55).86 HFCS has several commercial advantages over crystalline sugar (sucrose), its predecessor sweetener, such as convenience to transport and use (because it is a transferable and easily mixable liquid), less dependence on foreign sources
Metabolic Syndrome and Diabetes
The metabolic syndrome affects more than 50 million Americans,107 and increases the risk for atherosclerotic cardiovascular disease and type 2 diabetes, as well as mortality.108 Insulin may enhance renal urate reabsorption via stimulation of urate-anion exchanger109 and/or the Na+-dependent anion co-transporter in brush-border membranes of the renal proximal tubule.85 Higher insulin levels are known to reduce renal excretion of uric acid.110, 111, 112 A close association between serum urate
Conclusions
During the past few decades, the mean serum uric acid levels and the prevalence of hyperuricemia in the general population appear to have increased. Potential reasons behind these trends include the increasing prevalence of obesity and metabolic syndrome, Western lifestyle factors, increased prevalence of medical conditions, and medication use that increase uric acid levels. In addition, the substantial increase in sugar-sweetened soft drinks and fructose consumption coincides with the secular
References (135)
- et al.
Prevalence of the metabolic syndrome in individuals with hyperuricemia
Am J Med
(2007) - et al.
The prevalence and prophylaxis of gout in England
J Clin Epidemiol
(1995) - et al.
Recent trends of hyperuricemia and obesity in Japanese male adolescents, 1991 through 2002
Metabolism
(2004) - et al.
Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity
Am J Clin Nutr
(2004) - et al.
Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease
Am J Clin Nutr
(2007) - et al.
Reduction of serum uric acid by hormone replacement therapy in postmenopausal women with hyperuricaemia
Lancet
(1999) - et al.
The relation of postmenopausal hormone therapy to serum uric acid and the risk of coronary heart disease events: the Heart and Estrogen-Progestin Replacement Study (HERS)
Ann Epidemiol
(2006) - et al.
The distribution of serum uric acid values in a population unselected as to gout or hyperuricemia: Tecumseh, Michigan 1959-1960
Am J Med
(1965) - et al.
Effect of oral purines on serum and urinary uric acid of normal, hyperuricemic and gouty humans
J Nutr
(1976) - et al.
Levels of purines in foods and their metabolic effects in rats
J Nutr
(1976)
Milk- and soy-protein ingestion: acute effect on serum uric acid concentration
Am J Clin Nutr
Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch Nutrition Surveillance System)
J Clin Epidemiol
Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: demographic, physical, dietary and biochemical characteristics
J Chronic Dis
The Filipino and gout
Semin Arthritis Rheum
Alcohol intake and risk of incident gout in men: a prospective study
Lancet
Asymptomatic hyperuricemiaRisks and consequences in the Normative Aging Study
Am J Med
Gout and coronary heart disease: the Framingham Study
J Clin Epidemiol
Relations of hyperuricemia with the various components of the insulin resistance syndrome in young black and white adults: the CARDIA studyCoronary Artery Risk Development in Young Adults
Ann Epidemiol
Coffee consumption and risk of incident gout in women: the Nurses' Health Study
Am J Clin Nutr
Inhibitory effects of methylxanthines on the activity of xanthine oxidase
Life Sci
Caffeine ingestion increases the insulin response to an oral-glucose-tolerance test in obese men before and after weight loss
Am J Clin Nutr
The effect of ascorbic acid on uric acid excretion with a commentary on the renal handling of ascorbic acid
Am J Med
A case-control study of the association of diet and obesity with gout in Taiwan
Am J Clin Nutr
Straight talk about high-fructose corn syrup: what it is and what it ain't
Am J Clin Nutr
Are soft drinks a scapegoat for childhood obesity?
J Pediatr
Studies on the mechanism of fructose-induced hyperuricemia in man
Metab Clin Exp
Impaired cellular insulin binding and insulin sensitivity induced by high-fructose feeding in normal subjects
Am J Clin Nutr
Fructose-induced in vivo insulin resistance and elevated plasma triglyceride levels in rats
Am J Clin Nutr
Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis
Lancet
Purine-rich foods, dairy and protein intake, and the risk of gout in men
N Engl J Med
Incidence and risk factors for gout in white men
JAMA
Independent impact of gout on mortality and risk for coronary heart disease
Circulation
Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile
Rheumatology (Oxford)
Haemoglobin A1c, fasting glucose, serum C-peptide and insulin resistance in relation to serum uric acid levels—the Third National Health and Nutrition Examination Survey
Rheumatology (Oxford)
Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey
Arthritis Rheum
Hyperuricemia and coronary heart disease: a systematic review and meta-analysis
Arthritis Care Res (Hoboken)
Gout and mortality
Clin Exp Rheumatol
Hyperuricemia as a risk factor of coronary heart disease: the Framingham Study
Am J Epidemiol
Hyperuricemia and gout in Taiwan: results from the Nutritional and Health Survey in Taiwan (1993-96)
J Rheumatol
Trends in serum uric acid levels 1961-1980
Arthritis Rheum
Estimates of the prevalence of arthritis and other rheumatic conditions in the United StatesPart II
Arthritis Rheum
Gout epidemiology: results from the UK General Practice Research Database, 1990-1999
Ann Rheum Dis
Ten-year change in serum uric acid and its relation to changes in other metabolic risk factors in young black and white adults: the CARDIA study
Eur J Epidemiol
The changing epidemiology of gout
Nat Clin Pract Rheumatol
Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population
J Rheumatol
Rheumatic diseases in China
Arthritis Res Ther
Increasing gout prevalence in the US over the last two decades: the National Health and Nutrition Examination Survey (NHANES)
The serum urate-lowering impact of weight loss among men with a high cardiovascular risk profile: the Multiple Risk Factor Intervention Trial
Rheumatology
Prevalence of hyperuricemia in the US general population: the National Health and Nutrition Examination Survey (NHANES) 1999-2008
Food consumption, prices and expenditures, 1970-97US Department of Agriculture Economic Research Service Statistical Bulletin. No. 965
Cited by (131)
Impact of hyperuricemia on 5-year clinical outcomes following percutaneous transluminal angioplasty
2024, Cardiovascular Revascularization MedicineMusculoskeletal and immunological considerations
2023, Ketogenic: The Science of Therapeutic Carbohydrate Restriction in Human HealthThe relationship between anthropometric factors and hyperuricemia in adolescent athletes
2021, Obesity Research and Clinical PracticeSugar-sweetened soft drinks consumption and risk of hyperuricemia: Results of the ELSA-Brasil study
2021, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Other metabolic abnormalities induced by fructose seem to stimulate the synthesis of long-chain fatty acids leading to hypertriglyceridemia and insulin resistance [49], and both conditions have been associated with elevated serum uric acid levels [50]. In recent decades, increasing trends of hyperuricemia have been observed in several populations, mainly in western countries [21]. In Brazil, a population-based study that addressed the prevalence and epidemiological characteristics of hyperuricemia demonstrated an association between high levels of uric acid and cardiovascular risk factors (high BMI, abdominal obesity, and hypertriglyceridemia), and these being more pronounced in women [6].