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23-09-2019 | Rheumatology | News | Article

Modifiable risk factors account for substantial proportion of hyperuricemia cases

medwireNews: High BMI, non‐adherence to a DASH‐style diet, alcohol use, and diuretic use account for a substantial proportion of hyperuricemia cases in the US population, study findings indicate.

“However, the corresponding serum urate variance explained by these risk factors was very small and paradoxically masked their high prevalences, providing real‐life empirical evidence for its limitations in assessing common risk factors,” Hyon Choi (Harvard Medical School, Boston, Massachusetts, USA) and co-investigators remark.

Among 14,624 participants (mean age 47 years) of the US NHANES III study, 82% did not adhere to a DASH-style diet, which includes high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains, and low intake of sodium, sweetened beverages, and red and processed meats. In addition, 60% were overweight or obese (BMI ≥25 kg/m2), 48% consumed alcohol (any use), and 8% used diuretics.

Overall, 20% of participants were hyperuricemic (serum urate >417 µmol/L [7.0 mg/dL] among men and >340 µmol/L [5.7 mg/dL] among women).

As reported in Arthritis & Rheumatology, the most important risk factor for hyperuricemia was BMI, with 44% of cases attributed to overweight or obesity alone.

In addition, the population attributable risk (PAR) for non‐adherence to a DASH‐style diet was 9%, while that for any alcohol consumption was 8% and for diuretic use it was 12%.

All four variables were associated with serum urate levels and the presence of hyperuricemia in a dose‐response manner, but the researchers found that the corresponding degree of serum urate variance explained by each was much lower than the PAR.

Specifically, being overweight or obese, not consuming a DASH‐style diet, drinking alcohol, and using diuretics explained 8.9%, 0.1%, 0.5%, and 5.0% of the variance in serum urate levels, respectively.

The researchers note that the variance findings are in line with those of a recent meta-analysis, reported by medwireNews, which found that no more than 0.3% of serum urate variance in the US was explained by dietary components, whereas 23.9% was explained by common inherited genetic variants.

However, Choi and team stress that since “the variance explained depends on the level of spread of the exposure (its variability) without incorporating the exposure’s prevalence in the population, it can be highly misleading as a measure of relative importance among risk factors.”

They add: “This is particularly relevant when a risk factor is ubiquitous (and thus its variability is near-zero), in which case this approach leads to almost-none of the variance being explained, although almost all cases are related to the factor.”

Choi et al conclude that modifiable risk factors – BMI, the DASH diet, and alcohol and diuretic use – “all have an important place in the primary prevention of hyperuricemia.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Arthritis Rheumatol 2019; doi:10.1002/art.41067