Dietary Acid Load Is Positively Associated with the Incidence of Hyperuricemia in Middle-Aged and Older Korean Adults: Findings from the Korean Genome and Epidemiology Study.

Dayeon Shin,Kyung Won Lee

doi:10.3390/ijerph181910260

Abstract

Hyperuricemia has been associated with a number of chronic diseases, such as type 2 diabetes mellitus, hypertension, and cardiovascular diseases. Dietary acid load plays a key role in regulating uric acid levels. We hypothesized that potential renal acid load (PRAL) and net endogenous acid production (NEAP) score would be positively associated with the incidence of hyperuricemia. Data from the Health Examinees study, a part of the Korean Genome and Epidemiology Study were used. The PRAL and NEAP scores were calculated to evaluate the dietary acid load. Hyperuricemia was defined as follows: >7.0 mg/dL and >6.0 mg/dL of serum uric acid levels in men and women, respectively. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of hyperuricemia. We identified 2500 new cases of hyperuricemia during a mean follow-up of 5.0 years (223,552 person years). The participants in the highest quartiles of the PRAL and NEAP score had 21% (HR: 1.21, 95% CI: 1.07–1.35, p for trend <0.0001) and 17% (HR: 1.17, 95% CI: 1.04–1.31, p for trend <0.0001) higher risks for hyperuricemia, respectively, than those in the lowest quartiles, after adjusting for covariates. In this prospective cohort study, a higher dietary acid load was positively associated with a higher incidence of hyperuricemia in Korean adults. This suggests that an alkaline diet may be an effective strategy to reduce the future risk of elevated uric acid levels.

Highlights

Hyperuricemia, an elevated serum level of uric acid, is associated with numerous comorbidities, including renal [1,2] and cardiovascular diseases [2,3], metabolic syndrome [4], hypertension [5,6], diabetes mellitus [7], and obesity [8]
The Korean Genome and Epidemiology Study (KoGES) is a population-based prospective cohort study conducted by the Korea National Institute of Health [23]
Sociodemographic and lifestyle factors were presented according to the quartiles of the potential renal acid load (PRAL) score

Summary

Introduction

Hyperuricemia, an elevated serum level of uric acid, is associated with numerous comorbidities, including renal [1,2] and cardiovascular diseases [2,3], metabolic syndrome [4], hypertension [5,6], diabetes mellitus [7], and obesity [8]. The risk factors for hyperuricemia include reduced urate excretion, endogenous overproduction due to increased levels of purine degradation, or a combination of both [10]. Urate production is increased by endogenous purine production, high cell turnover states (for example, hemodialysis), and decreased excretion due to metabolic acidosis and renal insufficiency [11]. The serum uric acid level is affected by a diet rich in purine

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