Higher consumption of sugar-sweetened soft drinks increases the risk of hyperuricemia in Korean population: The Korean Multi-Rural Communities Cohort Study
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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Sugar-sweetened soft drinks consumption and risk of hyperuricemia: Results of the ELSA-Brasil study
2021, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :However, the consumption of unsweetened fruit juices was neither associated with a higher relative risk of hyperuricemia nor with higher serum uric acid levels. The positive association between sugar-sweetened beverages and increased serum uric acid levels is supported by cross-sectional studies carried out with populations in high- and middle-income countries in the last 15 years [2,13,17,18], including Brazil [16]. This is the first study to report a prospective association between sugar-sweetened soft drinks consumption and the incidence of hyperuricemia in a Brazilian cohort.
Sugar-containing carbonated beverages consumption is associated with hyperuricemia in general adults: A cross-sectional study
2020, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Previous studies have underlined the effects of sugar-containing soft beverages on the prevalence of hyperuricemia, but few studies evaluated the effects of sugar-containing carbonated beverages directly. Several cross-sectional studies, mainly focusing on the people of Western societies have shown that sugar-containing soft beverages, especially juice, had a positive effect on hyperuricemia [4,19,32,33]. Conversely, despite the worldwide popularity of sugar-containing carbonated beverages, sugar-containing carbonated beverages consumption in Asia is much lower than that in Western countries [21].
Diabetes mellitus and gout
2020, Diabetes Mellitus: Impact on Bone, Dental and Musculoskeletal HealthThe effect of vitamin C intake on the risk of hyperuricemia and plasma uric acid among Koreans. Multi-rural cohort
2015, Revue du Rhumatisme (Edition Francaise)The effect of vitamin C intake on the risk of hyperuricemia and serum uric acid level in Korean Multi-Rural Communities Cohort
2014, Joint Bone SpineCitation Excerpt :From the lessons, diverse lifestyle and dietary modifications are needed to reduce risks of cardiovascular and metabolic disorders and their mortality. Prescription against hyperuricemia includes daily regular exercise, intake of low fat dairy products, and restriction of alcoholic and sugary beverages [3,28]. In addition, enhanced consumption of vitamin C may be a beneficial strategy for the risk of hyperuricemia if some medical issues such as crystal-induced arthropathy and renal stone was not existed.
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.
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Corresponding authors contributed equally to this work.