Dietary, anthropometric, and biochemical determinants of uric acid in free-living adults

Nutrition Journal

Roberto Carlos Burini²  Liciana Vaz de Arruda Silveira¹  Fernando Moreto⁴  Erick Prado de Oliveira³ 

[1] Department of Bioestatistic Bioscience Institute (UNESP), Botucatu, Brazil;Center for exercise metabolism and nutrition (CeMENutri) Department of Public Health Botucatu School of Medicine (UNESP), Botucatu, Brazil;CeMENutri Departamento de Saúde Pública Faculdade de Medicina UNESP, Distrito de Rubião Jr. s/n°, Botucatu, SP, 18.618-970, Brazil;Department of Pathology Botucatu School of Medicine (UNESP), Botucatu, Brazil

关键词: Metabolic syndrome components;    Inflammation;    Body composition;    Diet;    Uric acid;   

Others  :  823678
DOI  :  10.1186/1475-2891-12-11

 received in 2012-02-18, accepted in 2013-01-11,  发布年份 2013

【 摘 要 】

Background

High plasma uric acid (UA) is a prerequisite for gout and is also associated with the metabolic syndrome and its components and consequently risk factors for cardiovascular diseases. Hence, the management of UA serum concentrations would be essential for the treatment and/or prevention of human diseases and, to that end, it is necessary to know what the main factors that control the uricemia increase. The aim of this study was to evaluate the main factors associated with higher uricemia values analyzing diet, body composition and biochemical markers.

Methods

415 both gender individuals aged 21 to 82 years who participated in a lifestyle modification project were studied. Anthropometric evaluation consisted of weight and height measurements with later BMI estimation. Waist circumference was also measured. The muscle mass (Muscle Mass Index – MMI) and fat percentage were measured by bioimpedance. Dietary intake was estimated by 24-hour recalls with later quantification of the servings on the Brazilian food pyramid and the Healthy Eating Index. Uric acid, glucose, triglycerides (TG), total cholesterol, urea, creatinine, gamma-GT, albumin and calcium and HDL-c were quantified in serum by the dry-chemistry method. LDL-c was estimated by the Friedewald equation and ultrasensitive C-reactive protein (CRP) by the immunochemiluminiscence method. Statistical analysis was performed by the SAS software package, version 9.1. Linear regression (odds ratio) was performed with a 95% confidence interval (CI) in order to observe the odds ratio for presenting UA above the last quartile (♂UA > 6.5 mg/dL and ♀ UA > 5 mg/dL). The level of significance adopted was lower than 5%.

Results

Individuals with BMI ≥ 25 kg/m² OR = 2.28(1.13-4.6) and lower MMI OR = 13.4 (5.21-34.56) showed greater chances of high UA levels even after all adjustments (gender, age, CRP, gamma-gt, LDL, creatinine, urea, albumin, HDL-c, TG, arterial hypertension and glucose). As regards biochemical markers, higher triglycerides OR = 2.76 (1.55-4.90), US-CRP OR = 2.77 (1.07-7.21) and urea OR = 2.53 (1.19-5.41) were associated with greater chances of high UA (adjusted for gender, age, BMI, waist circumference, MMI, glomerular filtration rate, and MS). No association was found between diet and UA.

Conclusions

The main factors associated with UA increase were altered BMI (overweight and obesity), muscle hypotrophy (MMI), higher levels of urea, triglycerides, and CRP. No dietary components were found among uricemia predictors.

【 授权许可】

   
2013 de Oliveira et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Manfredi JP, Holmes EW: Purine salvage pathways in myocardium. Annu Rev Physiol 1985, 47:691-705.
• [2]Sautin YY, Johnson RJ: Uric acid: the oxidant-antioxidant paradox. Nucleosides Nucleotides Nucleic Acids 2008, 27:608-619.
• [3]Maxwell SR, Thomason H, Sandler D, Leguen C, Baxter MA, Thorpe GH, Jones AF, Barnett AH: Antioxidant status in patients with uncomplicated insulin-dependent and non-insulin-dependent diabetes mellitus. Eur J Clin Invest 1997, 27:484-490.
• [4]Ma YS, Stone WL, LeClair IO: The effects of vitamin C and urate on the oxidation kinetics of human low-density lipoprotein. Proc Soc Exp Biol Med 1994, 206:53-59.
• [5]Hooper DC, Spitsin S, Kean RB, Champion JM, Dickson GM, Chaudhry I, Koprowski H: Uric acid, a natural scavenger of peroxynitrite, in experimental allergic encephalomyelitis and multiple sclerosis. Proc Natl Acad Sci U S A 1998, 95:675-680.
• [6]Wayner DD, Burton GW, Ingold KU, Barclay LR, Locke SJ: The relative contributions of vitamin E, urate, ascorbate and proteins to the total peroxyl radical-trapping antioxidant activity of human blood plasma. Biochim Biophys Acta 1987, 924:408-419.
• [7]Krishnan E, Pandya BJ, Chung L, Dabbous O: Hyperuricemia and the risk for subclinical coronary atherosclerosis - data from a prospective observational cohort study. Arthritis Res Ther 2011, 13:R66. BioMed Central Full Text
• [8]Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA: Hyperuricemia and risk of stroke: a systematic review and meta-analysis. Arthritis Rheum 2009, 61:885-892.
• [9]Takahashi MM, de Oliveira EP, de Carvalho AL, Dantas LA, Burini FH, Portero-McLellan KC, Burini RC: Metabolic Syndrome and dietary components are associated with coronary artery disease risk score in free-living adults: a cross-sectional study. Diabetol Metab Syndr 2011, 3:7. BioMed Central Full Text
• [10]Roddy E, Doherty M: Epidemiology of gout. Arthritis Res Ther 2010, 12:223. BioMed Central Full Text
• [11]Onat A, Uyarel H, Hergenc G, Karabulut A, Albayrak S, Sari I, Yazici M, Keles I: Serum uric acid is a determinant of metabolic syndrome in a population-based study. Am J Hypertens 2006, 19:1055-1062.
• [12]Doehner W, Schoene N, Rauchhaus M, Leyva-Leon F, Pavitt DV, Reaveley DA, Schuler G, Coats AJ, Anker SD, Hambrecht R: Effects of xanthine oxidase inhibition with allopurinol on endothelial function and peripheral blood flow in hyperuricemic patients with chronic heart failure: results from 2 placebo-controlled studies. Circulation 2002, 105:2619-2624.
• [13]Yu KH, See LC, Huang YC, Yang CH, Sun JH: Dietary factors associated with hyperuricemia in adults. Semin Arthritis Rheum 2008, 37:243-250.
• [14]Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G: Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004, 350:1093-1103.
• [15]Choi HK, Liu S, Curhan G: Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2005, 52:283-289.
• [16]de Oliveira EP, Manda RM, Torezan GA, Corrente JE, Burini RC: Dietary, anthropometric, and biochemical determinants of plasma high-density lipoprotein-cholesterol in free-living adults. Cholesterol 2011, 2011:851750.
• [17]Takahashi MM, de Oliveira EP, Moreto F, Portero-McLellan KC, Burini RC: Association of dyslipidemia with intakes of fruit and vegetables and the body fat content of adults clinically selected for a lifestyle modification program. Arch Latinoam Nutr 2010, 60:148-154.
• [18]Orsatti FL, Nahas EA, Orsatti CL, de Oliveira EP, Nahas-Neto J, da Mota GR, Burini RC: Muscle mass gain after resistance training is inversely correlated with trunk adiposity gain in postmenopausal women. J Strength Cond Res 2012, 26:2130-2139.
• [19]Moreto F, de Oliveira EP, Manda RM, Torezan GA, Teixeira O, Michelin E, Burini RC: Pathological and Behavioral Risk Factors for Higher Serum C-Reactive Protein Concentrations in Free-Living Adults-a Brazilian Community-Based Study. Inflammation 2012. in press
• [20]de Oliveira EP, Burini RC: High plasma uric acid concentration: causes and consequences. Diabetol Metab Syndr 2012, 4:12. BioMed Central Full Text
• [21]Kutzing MK, Firestein BL: Altered uric acid levels and disease states. J Pharmacol Exp Ther 2008, 324:1-7.
• [22]IBGE: Instituto Brasileiro de Geografia e Estatística. Estimativas da população residente em municípios brasileiros. Ministério do Planejamento, Orçamento e Estatística, 2006 [acesso em 12 de junho de 2008, disponível em. http://www.ibge.gov.br/home/estatistica/populacao/estimativa2006/estimativa.shtm webcite
• [23]Anção MS, Cuppari L, Draibe AS, Sigulem D: Programa de Apoio à Nutrição Nutwin Versão 1,5. São Paulo: Departamento de Informática em Saúde (DIS) da Escola Paulista de Medicina da Universidade Federal de São Paulo; 2002.
• [24]NEPA/UNICAMP: Tabela brasileira de composição de alimentos. Taco. Versão 1. Campinas. 2004. (http://189.28.128.100/nutricao/docs/taco/tab_bras_de_comp_de_alim_doc.pdf webcite)
• [25]IBGE: Tabela de Composição de Alimentos. 5th edition. Rio de Janeiro; 1999. (http://biblioteca.ibge.gov.br/visualizacao/monografias/GEBIS%20-%20RJ/endef/1999_Tabela%20de%20composicao%20de%20alimentos.pdf webcite)
• [26]Philippi ST: Tabela de Composição de Alimentos: Suporte para decisão nutricional. 2ªth edition. São Paulo: Coronário; 2002.
• [27]Mota JF, Rinaldi AEM, Pereira AF, Maestá N, Scarpin MM, Burini RC: Adaptation of the healthy eating index to the food guide of the Brazilian population. Rev Nutr 2008, 21:545-552.
• [28]Heyward VH, Stolarczyk LM: Avaliação da composição corporal aplicada. 1st edition. Barueri: Manole; 2000.
• [29]Segal KR, Van Loan M, Fitzgerald PI, Hodgdon JA, Van Itallie TB: Lean body mass estimation by bioelectrical impedance analysis: a four-site cross-validation study. Am J Clin Nutr 1988, 47:7-14.
• [30]Janssen I, Heymsfield SB, Baumgartner RN, Ross R: Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 2000, 89:465-471.
• [31]“Sociedade Brasileira de Cardiologia / Sociedade Brasileira de Hipertensão / Sociedade Brasileira de Nefrologia: VI Diretrizes Brasileiras de Hipertensão. Arq Bras Cardiol 2010, 95(1 supl.1):1-51.
• [32]Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) Jama 2001, 285:2486-2497. http://www.ncbi.nlm.nih.gov/pubmed/11368702 webcite
• [33]Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report Circulation 2002, 106:3143-3421. http://www.ncbi.nlm.nih.gov/pubmed/12485966 webcite
• [34]Friedewald WT, Levy RI, Fredrickson DS: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972, 18:499-502.
• [35]Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron 1976, 16:31-41.
• [36]American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2004, 27(1):5-10.
• [37]WHO: Report of a joint FAO/WHO Consultation. Preparation and use of food-based Dietary Guidelines. Geneva: World Health Organization; 2002.
• [38]Bray G: An approach to the classification and evaluation of obesity. In Obesity. Edited by Björntorp P, Brodoff BN. New York: JB Lippincott Company; 1992:294-308.
• [39]Vekic J, Kotur-Stevuljevic J, Jelic-Ivanovic Z, Spasic S, Spasojevic-Kalimanovska V, Topic A, Zeljkovic A, Stefanovic A, Zunic G: Association of oxidative stress and PON1 with LDL and HDL particle size in middle-aged subjects. Eur J Clin Invest 2007, 37:715-723.
• [40]Shima Y, Teruya K, Ohta H: Association between intronic SNP in urate-anion exchanger gene, SLC22A12, and serum uric acid levels in Japanese. Life Sci 2006, 79:2234-2237.
• [41]Choe JY, Park SH, Kim JY, Shin IH, Kim SK: Change in serum uric acid between baseline and 1-year follow-up and its associated factors in male subjects. Clin Rheumatol 2008, 27:483-489.
• [42]Rathmann W, Haastert B, Icks A, Giani G, Roseman JM: 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 2007, 22:439-445.
• [43]Sun X, Chen Y, Chen X, Wang J, Xi C, Lin S, Liu X: Change of glomerular filtration rate in healthy adults with aging. Nephrology (Carlton) 2009, 14:506-513.
• [44]Bonora E, Targher G, Zenere MB, Saggiani F, Cacciatori V, Tosi F, Travia D, Zenti MG, Branzi P, Santi L, Muggeo M: Relationship of uric acid concentration to cardiovascular risk factors in young men. Role of obesity and central fat distribution. The Verona Young Men Atherosclerosis Risk Factors Study. Int J Obes Relat Metab Disord 1996, 20:975-980.
• [45]Matsuura F, Yamashita S, Nakamura T, Nishida M, Nozaki S, Funahashi T, Matsuzawa Y: Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism 1998, 47:929-933.
• [46]Hikita M, Ohno I, Mori Y, Ichida K, Yokose T, Hosoya T: Relationship between hyperuricemia and body fat distribution. Intern Med 2007, 46:1353-1358.
• [47]Tamba S, Nishizawa H, Funahashi T, Okauchi Y, Ogawa T, Noguchi M, Fujita K, Ryo M, Kihara S, Iwahashi H, et al.: Relationship between the serum uric acid level, visceral fat accumulation and serum adiponectin concentration in Japanese men. Intern Med 2008, 47:1175-1180.
• [48]Bedir A, Topbas M, Tanyeri F, Alvur M, Arik N: Leptin might be a regulator of serum uric acid concentrations in humans. Jpn Heart J 2003, 44:527-536.
• [49]Fruehwald-Schultes B, Peters A, Kern W, Beyer J, Pfutzner A: Serum leptin is associated with serum uric acid concentrations in humans. Metabolism 1999, 48:677-680.
• [50]Valtuena S, Numeroso F, Ardigo D, Pedrazzoni M, Franzini L, Piatti PM, Monti L, Zavaroni I: Relationship between leptin, insulin, body composition and liver steatosis in non-diabetic moderate drinkers with normal transaminase levels. Eur J Endocrinol 2005, 153:283-290.
• [51]Facchini F, Chen YD, Hollenbeck CB, Reaven GM: Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. Jama 1991, 266:3008-3011.
• [52]Chen LY, Zhu WH, Chen ZW, Dai HL, Ren JJ, Chen JH, Chen LQ, Fang LZ: Relationship between hyperuricemia and metabolic syndrome. J Zhejiang Univ Sci B 2007, 8:593-598.
• [53]Clausen JO, Borch-Johnsen K, Ibsen H, Pedersen O: Analysis of the relationship between fasting serum uric acid and the insulin sensitivity index in a population-based sample of 380 young healthy Caucasians. Eur J Endocrinol 1998, 138:63-69.
• [54]Conen D, Wietlisbach V, Bovet P, Shamlaye C, Riesen W, Paccaud F, Burnier M: Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country. BMC Publ Health 2004, 4:9. BioMed Central Full Text
• [55]Schachter M: Uric acid and hypertension. Curr Pharm Des 2005, 11:4139-4143.
• [56]Summers GD, Deighton CM, Rennie MJ, Booth AH: Rheumatoid cachexia: a clinical perspective. Rheumatology (Oxford) 2008, 47:1124-1131.
• [57]Ruggiero C, Cherubini A, Ble A, Bos AJ, Maggio M, Dixit VD, Lauretani F, Bandinelli S, Senin U, Ferrucci L: Uric acid and inflammatory markers. Eur Heart J 2006, 27:1174-1181.
• [58]Beavers KM, Beavers DP, Serra MC, Bowden RG, Wilson RL: Low relative skeletal muscle mass indicative of sarcopenia is associated with elevations in serum uric acid levels: Findings from NHANES III. Journal of Nutrition, Health and Aging 2009, 13:177-182.
• [59]Powers SK, Kavazis AN, DeRuisseau KC: Mechanisms of disuse muscle atrophy: role of oxidative stress. Am J Physiol Regul Integr Comp Physiol 2005, 288:R337-R344.
• [60]Vekic J, Jelic-Ivanovic Z, Spasojevic-Kalimanovska V, Memon L, Zeljkovic A, Bogavac-Stanojevic N, Spasic S: High serum uric acid and low-grade inflammation are associated with smaller LDL and HDL particles. Atherosclerosis 2009, 203:236-242.
• [61]Kanellis J, Kang DH: Uric acid as a mediator of endothelial dysfunction, inflammation, and vascular disease. Semin Nephrol 2005, 25:39-42.
• [62]Bo S, Gambino R, Durazzo M, Ghione F, Musso G, Gentile L, Cassader M, Cavallo-Perin P, Pagano G: Associations between serum uric acid and adipokines, markers of inflammation, and endothelial dysfunction. J Endocrinol Invest 2008, 31:499-504.
• [63]Schmidt MI, Watson RL, Duncan BB, Metcalf P, Brancati FL, Sharrett AR, Davis CE, Heiss G: Clustering of dyslipidemia, hyperuricemia, diabetes, and hypertension and its association with fasting insulin and central and overall obesity in a general population Atherosclerosis Risk in Communities Study Investigators. Metabolism 1996, 45:699-706.
• [64]Evans JL, Maddux BA, Goldfine ID: The molecular basis for oxidative stress-induced insulin resistance. Antioxid Redox Signal 2005, 7:1040-1052.
• [65]Tsouli SG, Liberopoulos EN, Mikhailidis DP, Athyros VG, Elisaf MS: Elevated serum uric acid levels in metabolic syndrome: an active component or an innocent bystander? Metabolism 2006, 55:1293-1301.
• [66]Emmerson BT: The management of gout. N Engl J Med 1996, 334:445-451.
• [67]Yu T, Yu TF: Milestones in the treatment of gout. Am J Med 1974, 56:676-685.
• [68]Choi HK, Curhan G: Beer, liquor, and wine consumption and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2004, 51:1023-1029.
• [69]Ghadirian P, Shatenstein B, Verdy M, Hamet P: The influence of dairy products on plasma uric acid in women. Eur J Epidemiol 1995, 11:275-281.
• [70]Choi HK, Curhan G: Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey. Arthritis Rheum 2007, 57:816-821.