Elsevier

Nutrition

Volume 93, January 2022, 111501
Nutrition

Applied nutritional investigation
Dietary patterns and risk for hyperuricemia in the general population: Results from the TCLSIH cohort study

https://doi.org/10.1016/j.nut.2021.111501Get rights and content

Highlights

  • The animal food pattern, a major source of purine, was positively associated with a higher risk for hyperuricemia.

  • The fructose-rich sweet pattern was independently associated with incidence of hyperuricemia.

  • The vegetable pattern tended to contain lower saturated fat and higher phytochemical-rich foods.

  • The dietary patterns study established potential preventive strategies against hyperuricemia.

Abstract

Objective

Prospective cohort studies linking dietary patterns and hyperuricemia (HUA) are limited, especially in Asian populations. The aim of this study was to prospectively investigate the association between various dietary patterns and risk for HUA in a general adult population.

Method

We used data from the TCLSIH (Tianjin Chronic Low-grade Systemic Inflammation and Health) cohort study of 20 766 men and women who were free from HUA, cancer, and cardiovascular disease at baseline. Dietary patterns at baseline were identified with factor analysis based on responses to a validated 81-item food frequency questionnaire. HUA was defined as serum uric acid levels >420 μmol/L in men and >350 μmol/L in women. Cox proportional hazards regression models were used to examine the association of dietary patterns with incident HUA.

Results

In all, 4389 first incident cases of HUA occurred during 73 822 person-years of follow-up (median follow-up of 4.2 y). Three main dietary patterns were extracted. They were the vegetable, sweet food, and animal food patterns. After adjusting for demographic characteristics, lifestyle factors, other dietary pattern scores, and inflammatory markers, comparing the highest with the lowest quartiles of dietary pattern scores, the multivariable hazard ratios (95% confidence interval) of HUA were 0.79 (0.72–0.87; Ptrend < 0.0001) for the vegetable pattern, 1.22 (1.12–1.33; Ptrend < 0.0001) for the sweet food pattern, and 1.24 (1.13–1.37; Ptrend < 0.0001) for the animal food pattern.

Conclusions

Dietary patterns rich in animal or sweet foods were positively associated with a higher risk for HUA, whereas the vegetable pattern was negatively associated.

Introduction

Uric acid is the end product of the metabolism of purine compounds in humans and some primate species and is produced in the liver from degradation of dietary and endogenously synthesized purine compounds. The balance between hepatic production of uric acid and intestinal or renal uric acid excretion pathways determines an individual's serum uric acid (SUA) levels [1]. Elevated SUA concentrations can lead to uric acid supersaturation, causing hyperuricemia (HUA). HUA is a central risk factor for gout, which causes deposition of urate crystals and results in gouty arthritis in some individuals. It also has been reported to be an important risk factor for hypertension, cardiovascular disease (CVD), metabolic syndrome (MetS), and renal disease [2]. The prevalence of HUA has doubled worldwide over the past few decades [3] and varies widely by age, sex, and lifestyle. The prevalence of HUA is reported to be 21.2% in men and 21.6% in women in the United States [4], and 21.6% in men and 8.6% in women in China [5].

Evidence has suggested that diet plays a major role in management of HUA [6,7] and there is growing interest in the benefit of specific foods against the progression of HUA [8], [9], [10]. However, single food or nutrient studies do not adequately reflect the overall effects of food combinations. Therefore, examinations of dietary patterns, which assess the effects of overall diet as determined by factor analysis, can be proxy indicators of real food consumption and availability. These may provide a more realistic representation of everyday eating habits [11]. Previous work on the association between dietary patterns and HUA were focused on cross-sectional study designs [12], [13], [14], [15], [16], which may suffer from reverse causation as participants with HUA changed their diet to reduce high purine food intake. Thus, we conducted a large prospective cohort study to investigate whether different dietary patterns were associated with incident HUA in the general population.

Section snippets

Participants

This prospective cohort study used data from the TCLSIH or TCLSIHealth (Tianjin Chronic Low-grade Systemic Inflammation and Health) [17,18], ranging from 2013 to 2019. The study recruited men and women ≥18 y of age from the general population living in Tianjin, China for ≥5 y. In brief, all participants were administered a detailed lifestyle questionnaire survey (including their dietary intake, physical activity [PA], household income, occupation, and educational level, etc.) since May 2013,

Results

Table 1 shows the top 20 food items and factor loadings of the principal component analysis-extracted dietary patterns. The first pattern was characterized by a high intake of celery, cucumber, Chinese cabbage, green leafy vegetables, pumpkin, and carrot and therefore was named the vegetable pattern. The second pattern had high factor loadings for strawberry, kiwi fruit, persimmon, grape, pineapple, Western-style pastry, cakes, sweets, and candied fruits and was named the sweet food pattern.

Discussion

In this large-scale prospective study of Chinese adults, three main dietary patterns were identified: vegetable pattern, sweet food pattern, and animal food pattern. We found that greater adherence to either the animal or the sweet food pattern was significantly positively associated with a higher risk for HUA, whereas there was a negative association for the vegetable pattern. The association between dietary patterns and risk for HUA was robust in the subgroup analyses. To our knowledge, this

Conclusion

In the general population, following either an animal food or sweet food pattern diet was associated with an increased risk for HUA, while following a vegetable pattern diet was negatively associated with HUA risk. These findings provide valuable information to establish potential preventive strategies against HUA through dietary modifications.

Acknowledgments

The authors acknowledge the individuals involved in this study.

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    This study was supported by grants from the National Natural Science Foundation of China (Nos. 81941024, 91746205, 81872611 and 81673166), National Key Research and Development Project-Study on Diet and Nutrition Assessment and Intervention Technology (No. 2020YFC2006300), National Health Commission of China (No. SPSYYC 2020015) and 2014 and 2016 Chinese Nutrition Society (CNS) Nutrition Research Foundation—DSM Research Fund (Nos. 2016-046, 2014- 071 and 2016-023), China. TZ analyzed the data and wrote the paper. TZ, SR, GM, QZ, LL, HW, YG, YW, SZ, XW, JZ, HL, AT, SS, XW, MZ, QJ, and KS conducted the research. KN designed the research and had primary responsibility for final content. The authors have no conflicts of interest to declare.

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