Hyperuricemia and hypertriglyceridemia: Metabolic basis for the association

Abstract

Hypertriglyceridemia has been reported frequently in patients with hyperuricemia and gout. The current studies have evaluated this relationship. To examine whether hypertriglyceridemia leads to hyperuricemia, IV Intralipid was given to three gouty patients. Triglycerides increased from 169 to 700 mg/dl for three hours but caused no change in serum urate level or urine uric acid and oxypurine excretion. We next examined whether high carbohydrate intake increases serum urate and triglyceride levels. Four obese patients were placed on a 2000 kcal/d sucrose diet for seven days. The serum urate increased from 6.3 ± 1.7 to 7.9 ± 2.0 mg/dL. The percent uric acid clearance to creatinine clearance decreased from 5.9 ± 1.3 to the lowest mean value of 3.7 ± 1.2, while serum triglycerides increased from 106 ± 33 to 252 ± 57 mg/dL and blood lactate from 607 ± 227 to 1167 ± 381 μmol/L. A 3000 kcal/d glucose diet in four other obese subjects produced no change in serum urate levels but increased lactate and triglyceride levels. During an isocaloric sucrose diet in two normal men, the serum urate level increased from 5.3 and 4.0 to peak values of 9.5 and 7.4 mg/dL. The percent uric acid to creatinine clearance decreased from 5.6 and 6.6 to 2.9 and 3.3. The uric acid turnover did not increase. In three gouty patients the mean serum urate increased from 8.5 ± 1.5 to 10.6 ± 1.4 mg/dL following an isocaloric sucrose diet. The urine uric acid excretion increased from 0.30 and 0.25 to 0.37 and 0.38 mg/mg creatinine in two patients. The percent uric acid clearance to creatinine clearance decreased from 3.8 to 2.5 in one patient. The serum triglycerides were substantially elevated during the sucrose diet in the normal subjects and the gouty patients. Our studies show that a pure sucrose diet increases both the serum urate and triglyceride levels. The mechanism of the hyperuricemia is decreased renal clearance of uric acid in the obese normal controls and the normal subjects. Increased urate production and decreased uric acid clearance accounted for the hyperuricemia in the gouty patients. The contribution of excessive sucrose ingestion to clinically associated hyperuricemia and hypertriglyceridemia remains to be elucidated.