Higher consumption of sugar-sweetened soft drinks increases the risk of hyperuricemia in Korean population: The Korean Multi-Rural Communities Cohort Study

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Abstract

Objective

The clinical implication of sugar-sweetened soft drinks on the risk of hyperuricemia has increased, especially in Western population studies. The aim of this study is to clarify the association between sugar-sweetened soft drinks and fruit drinks made from oranges and apples and the risk of hyperuricemia in the Korean Multi-Rural Communities Cohort.

Methods

A total of 9400 subjects were enrolled in the Korean Multi-Rural Communities Cohort Study, and a cross-sectional analysis was performed. Five quintiles (Q1–Q5) according to consumption of soft drinks and other fruit/fruit juices were classified and then categorized into three groups (Q1–Q3, Q4, and Q5) to assess the risk of hyperuricemia. Information on dietary intake was collected by well-trained interviewers using validated food frequency questionnaires.

Results

Higher consumption of sugar-sweetened soft drinks (Q5) increased the risk of hyperuricemia in males (adjusted OR = 1.35, 95% CI: 1.07–1.71) with a linear trend (p for trend = 0.01) and in females (adjusted OR = 1.40, 95% CI: 1.03–1.90) with no linear trend (p for trend = 0.09), compared to lower consumption (Q1–Q3). However, there were no significant differences of serum uric acid level according to the three categories of soft drink consumption, Q1–Q3, Q3, and Q5, in males (p = 0.21) or in females (p = 0.16), whereas all subjects showed statistical significance of serum uric acid level within the categories (p < 0.001). Estimated amount of soft drink intake was associated with serum uric acid level in males (β = 0.001; p = 0.01) but not in females (β = 0.0005; p = 0.10).

Conclusion

Higher consumption of sugar-sweetened soft drinks increased the risk of hyperuricemia in the Korean population, showing a differential linear trend for hyperuricemia according to gender.

Introduction

Hyperuricemia occurs as a result of overproduction or aberration of renal processing of uric acid, a final catabolite of purine derived from DNA and RNA in humans [1]. The prevalence of hyperuricemia has gradually increased during the past several decades according to diverse demographic population studies, with an increased trend of serum uric acid level between observation periods [2]. Clinical significance of hyperuricemia is associated with risk factors related to diverse systemic diseases including obesity, diabetes mellitus, metabolic syndrome, gout, and cardiovascular diseases [3], [4]. High-purine diets from meat and seafood consumption and alcohol intake have been traditionally considered important risk factors for the development of increased serum uric acid level [5], [6]. Therefore, restriction of purine and alcohol has been recommended to prevent the development of hyperuricemia.

Recently, several epidemiological studies using United States national data have found that sugar-sweetened soft drinks were significantly associated with increased serum uric acid level [7], [8], [9]. Furthermore, prospective data suggested that consumption of sugar-sweetened soft drinks has the potential to increase the risk of hyperuricemia and gout in males [10]. Basically, sugar, or sucrose, is chemically a disaccharide composed of two monosaccharides such as fructose and glucose. Among them, fructose, unlike glucose, can play a role as a source of intracellular uric acid production and results in increased serum uric acid level [11]. Epidemiological studies suggest that fructose consumption may contribute to increased risk of hyperuricemia and gout [7], [10], [12]. Based on these studies, the non-pharmacological guideline for the management of gout from the American College of Rheumatology recommends avoidance of high-fructose corn syrup-sweetened drinks [13].

Increased trends of prevalence in hyperuricemia were consistently found in various ethnic and racial study groups [2]. However, some discrepancies in the prevalence of hyperuricemia were also observed in various populations, as illustrated in the data derived from the Third US National Health and Nutritional Examination Survey (NHANES-III) [14] and the Nutritional and Health Survey in Taiwan [15], which could potentially be due to different dietary patterns and lifestyle. In addition, serum uric acid level may be affected by genetic and environmental influences [2]. Limited data regarding the association between sugar-sweetened soft drinks and serum uric acid level in the Asian population exists, although several epidemiologic results originating from residents in North America have been reported. Therefore, in this study, we assessed the association between sugar-sweetened soft drinks and other drinks originating from fruits such as orange and apple and the risk of hyperuricemia in the Korean Multi-Rural Communities Cohort.

Section snippets

Study population

The Korean Multi-Rural Communities Cohort Study has been conducted as a part of the Korean Genome Epidemiology Study since 2004. The Korean Multi-Rural Communities Cohort is a multi-center prospective cohort designed to identify risk factors for cardiovascular diseases in the Korean population. This community-based cohort targeted residents aged ≥40 years living in one of three rural areas, Yangpyeong (located in the eastern part of Seoul, the capital of South Korea), Namwon (located in the

General characteristics of the study population

A total of 9400 subjects (n = 3564; 37.9% males and n = 5836; 62.1% females) provided demographic, health-related, laboratory, and dietary intake information at the enrollment in the Korean Multi-Rural Communities Cohort (Table 1). The mean level of serum uric acid in all subjects was 4.91 mg/dL (SD = 1.43). The difference of serum uric acid level between male and female participants was approximately 1.4 mg/dL; 5.8 mg/dL (SD = 1.5) for males and 4.4 mg/dL (SD = 1.1) for females, a statistically

Discussion

In the analysis of the Korean Multi-Rural Communities Cohort, we found that both male and female subjects consuming more sugar-sweetened soft drinks had an increased risk of hyperuricemia after adjustment for various confounders such as age, education, marital status, cigarette smoking, alcohol drinking, regular exercise, BMI, anti-hypertensive medication, total energy, and vitamin C, meat, seafood, dairy, coffee, and tea intake. In contrast, oranges, apples, and juices extracted from these

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    This research was supported by a fund (2004-E71004-00, 2005-E71011-00, 2006-E71009-00, 2007-E71002-00, 2008-E71004-00, and 2009-E71006-00) by Research of Korea Centers for Disease Control and Prevention.

    1

    Corresponding authors contributed equally to this work.

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