Abstract
Alcohol intake and excess adiposity are associated with serum uric acid (SUA), but their interaction effect on hyperuricemia (HUA) remains unclear. Using data from the China National Health Survey (CNHS) (2012–2017), we analyzed the additive interaction of beer, spirits intake, excess adiposity [measured by body mass index (BMI), body fat percentage (BFP), and visceral fat index (VFI)] with HUA among male participants aged 20–80 from mainland China. The relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and the synergy index (SI) were calculated to assess the interaction effect on the additive scale. Both RERI and AP larger than 0 and SI larger than 1 indicate a positive additive interaction. Among 12,592 male participants, the mean SUA level was 367.1 ± 85.5 μmol/L and 24.1% were HUA. Overweight/obese men who were presently drinking spirits had an odds ratio (OR) of 3.20 (95%CI: 2.71–3.79) than the never drink group, with RERI, AP, and SI of 0.45 (95%CI: 0.08–0.81), 0.14 (95%CI: 0.03–0.25), and 1.25 (95%CI: 1.02–1.54), respectively. However, although combined exposures on beer intake and excess adiposity had the highest OR compared with no beer intake and nonobese participants, there was no additive interaction, with RERI, AP, and SI in the overweight/obesity and the beer intake group of 0.58 (−0.41–1.57), 0.17 (−0.08–0.41), and 1.30 (0.85–1.97), respectively. Other excess adiposity indexes revealed similar estimates. Our findings suggested that the exposures of both excess adiposity and alcohol drink could result in an additive interaction effect on HUA: the combined risk of excess adiposity with spirits intake but not with beer was greater than the sum of the effects among Chinese male adults.
Highlights
Hyperuricemia (HUA) is a causal component necessary for the development of gout [1] and is associated with multiple cardiometabolic diseases [1, 2]
After the estimation of the joint effect of overall alcohol use with adiposity on HUA, we found that current drinking in the obese population (BMI > 25, body fat percentage (BFP) > 25, or visceral fat index (VFI) > 15) had the highest HUA prevalence and the highest odds ratios (ORs)
Using data from the China National Health Survey (CNHS), we demonstrated that body composition and alcohol use had an additive interaction effect on HUA, after adjusting for potential confounders
Summary
Hyperuricemia (HUA) is a causal component necessary for the development of gout [1] and is associated with multiple cardiometabolic diseases [1, 2]. It is well known that excess adiposity and alcohol consumption are the most essential modifiable risk factors for cardiometabolic diseases, and previous studies have explored their interaction role toward metabolic health [9, 10]. The measurement of interaction on the additive scale [14], such as the relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and synergy index (SI) can be used to assess whether there is a synergism between excess body fat and alcohol use. As previous studies have indicated the causal effect of excess body fat and alcohol use on HUA [6, 15], RERI > 0 can imply such synergism [16]. AP was intended to capture the proportion of the disease in the doubly exposed group that is due to the interaction between the two exposures [17]
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