Associations between dietary iron intake from different sources and the risk of hyperuricemia among US adults: a cross-sectional study
Background: Currently available evidence on the association between dietary iron intake and hyperuricemia is limited and inconsistent.
Objective: This study aimed to examine the relationships between animal-derived dietary iron (ADDI) intake, plant-derived dietary iron (PDDI) intake, and the ratio PDDI:ADDI and hyperuricemia risk among US adults.
Design: Data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014 were used. Iron intake from diet was assessed through two 24-h dietary recalls. Logistic regression models and restricted cubic spline models were used to investigate the associations between dietary iron intake from different sources and hyperuricemia risk.
Results: A total of 12,869 participants aged ≥20 years were enrolled in the study. After adjustment for multiple confounders, relative to the lowest quartile, the odds ratios (ORs) with 95% confidence intervals (CIs) of hyperuricemia for the highest quartile of ADDI intake, PDDI intake, and the PDDI:ADDI intake ratio were 1.11 (0.90–1.38), 0.69 (0.55–0.87), and 0.85 (0.67–1.07), respectively. Dose–response analysis revealed that the risk of hyperuricemia was negatively associated with PDDI intake in a linear manner.
Conclusion: PDDI intake was inversely associated with hyperuricemia in US adults.
- Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. Am J Med 2007; 120(5): 442–7. doi: 10.1016/j.amjmed.2006.06.040.
- Puig JG, Martinez MA, Mora M, Fraile JM, Montoya F, Torres RJ. Serum urate, metabolic syndrome, and cardiovascular risk factors. A population-based study. Nucleos Nucleot Nucleic Acids 2008; 27(6): 620–3. doi: 10.1080/15257770802138582.
- Kleber ME, Delgado G, Grammer TB, Silbernagel G, Huang J, Kramer BK, et al. Uric acid and cardiovascular events: a Mendelian randomization study. J Am Soc Nephrol 2015; 26(11): 2831–8. doi: 10.1681/asn.2014070660.
- Xu X, Hu J, Song N, Chen R, Zhang T, Ding X. Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis. BMC Nephrol 2017; 18(1): 27. doi: 10.1186/s12882016-0433-1.
- Jia Z, Zhang X, Kang S, Wu Y. Serum uric acid levels and incidence of impaired fasting glucose and type 2 diabetes mellitus: a meta-analysis of cohort studies. Diabetes Res Clin Pract 2013; 101(1): 88–96. doi: 10.1016/j.diabres.2013.03.026.
- Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: The National Health and Nutrition Examination Survey, 2007–2016. Arthritis Rheumatol 2019; 71(6): 991–9. doi: 10.1002/art.40807.
- Liu R, Han C, Wu D, Xia X, Gu J, Guan H, et al. Prevalence of hyperuricemia and gout in mainland China from 2000 to 2014: a systematic review and meta-analysis. Biomed Res Int 2015; 2015: 762820. doi: 10.1155/2015/762820.
- Kim Y, Kang J, Kim GT. Prevalence of hyperuricemia and its associated factors in the general Korean population: an analysis of a population-based nationally representative sample. Clin Rheumatol 2018; 37(9): 2529–38. doi: 10.1007/s10067-018-4130-2.
- Liu H, Zhang XM, Wang YL, Liu BC. Prevalence of hyperuricemia among Chinese adults: a national cross-sectional survey using multistage, stratified sampling. J Nephrol 2014; 27(6): 653–8. doi: 10.1007/s40620-014-0082-z.
- Qiu L, Cheng XQ, Wu J, Liu JT, Xu T, Ding HT, et al. Prevalence of hyperuricemia and its related risk factors in healthy adults from Northern and Northeastern Chinese provinces. BMC Public Health 2013; 13: 664. doi: 10.1186/1471-2458-13-664.
- Merriman TR. An update on the genetic architecture of hyperuricemia and gout. Arthritis Res Ther 2015; 17: 98. doi: 10.1186/s13075-015-0609-2.
- Choi HK, Curhan G. Beer, liquor, and wine consumption and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2004; 51(6): 1023-9. doi: 10.1002/art.20821.
- Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2005; 52(1): 283–9. doi: 10.1002/art.20761.
- Zgaga L, Theodoratou E, Kyle J, Farrington SM, Agakov F, Tenesa A, et al. The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study. PLoS One 2012; 7(6): e38123. doi: 10.1371/journal.pone.0038123.
- Sun Y, Sun J, Wang J, Gao T, Zhang H, Ma A. Association between vitamin C intake and risk of hyperuricemia in US adults. Asia Pac J Clin Nutr 2018; 27(6): 1271–6. doi: 10.6133/apjcn.201811_27(6).0014.
- Yu KH, See LC, Huang YC, Yang CH, Sun JH. Dietary factors associated with hyperuricemia in adults. Semin Arthritis Rheum 2008; 37(4): 243–50. doi: 10.1016/j.semarthrit.2007.04.007.
- Zhang Y, Qiu H. Folate, Vitamin B6 and vitamin B12 intake in relation to hyperuricemia. J Clin Med 2018; 7(8). pii: E210. doi: 10.3390/jcm7080210.
- Zhang Y, Qiu H. Dietary magnesium intake and hyperuricemia among US adults. Nutrients 2018; 10(3). pii: E296. doi: 10.3390/nu10030296.
- Furth-Walker D, Amy NK. Regulation of xanthine oxidase activity and immunologically detectable protein in rats in response to dietary protein and iron. J Nutr 1987; 117(10): 1697–703. doi: 10.1093/jn/117.10.1697.
- Ghio AJ, Kennedy TP, Stonehuerner J, Carter JD, Skinner KA, Parks DA, et al. Iron regulates xanthine oxidase activity in the lung. Am J Physiol Lung Cell Mol Physiol 2002; 283(3): L563–72. doi: 10.1152/ajplung.00413.2000.
- Martelin E, Lapatto R, Raivio KO. Regulation of xanthine oxidoreductase by intracellular iron. Am J Physiol Cell Physiol 2002; 283(6): C1722–8. doi: 10.1152/ajpcell.00280.2002.
- Flais J, Bardou-Jacquet E, Deugnier Y, Coiffier G, Perdriger A, Chales G, et al. Hyperferritinemia increases the risk of hyperuricemia in HFE-hereditary hemochromatosis. Joint Bone Spine 2017; 84(3): 293–7. doi: 10.1016/j.jbspin.2016.05.020.
- Ghio AJ, Ford ES, Kennedy TP, Hoidal JR. The association between serum ferritin and uric acid in humans. Free Radic Res 2005; 39(3): 337–42. doi: 10.1080/10715760400026088.
- Li X, He T, Yu K, Lu Q, Alkasir R, Guo G, et al. Markers of iron status are associated with risk of hyperuricemia among Chinese adults: nationwide population-based study. Nutrients 2018; 10(2): 191. doi: 10.3390/nu10020191.
- Ryu KA, Kang HH, Kim SY, Yoo MK, Kim JS, Lee CH, et al. Comparison of nutrient intake and diet quality between hyperuricemia subjects and controls in Korea. Clin Nutr Res 2014; 3(1): 56–63. doi: 10.7762/cnr.2014.3.1.56.
- Zykova SN, Storhaug HM, Toft I, Chadban SJ, Jenssen TG, White SL. Cross-sectional analysis of nutrition and serum uric acid in two Caucasian cohorts: the AusDiab Study and the Tromso study. Nutr J 2015; 14: 49. doi: 10.1186/s12937-015-0032-1.
- Layrisse M, Cook JD, Martinez C, Roche M, Kuhn IN, Walker RB, et al. Food iron absorption: a comparison of vegetable and animal foods. Blood 1969; 33(3): 430–43. doi: 10.1182/blood.V33.3.430.430.
- Fang J, Alderman MH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971–1992. National Health and Nutrition Examination Survey. JAMA 2000; 283(18): 2404–10. doi: 10.1001/jama.283.18.2404.
- Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA 2015; 314(10): 1021–9. doi: 10.1001/jama.2015.10029.
- Whelton PK, Carey RM, Aronow WS, Casey DE, Jr., Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71(6): e13–e115. doi: 10.1161/hyp.0000000000000065.
- Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 1997; 65(4 Suppl): 1220S–8S; discussion 9S–31S. doi: 10.1093/ajcn/65.4.1220S.
- Ruggiero C, Cherubini A, Ble A, Bos AJ, Maggio M, Dixit VD, et al. Uric acid and inflammatory markers. Eur Heart J 2006; 27(10): 1174–81. doi: 10.1093/eurheartj/ehi879.
- Liu J, Shen P, Ma X, Yu X, Ni L, Hao X, et al. White blood cell count and the incidence of hyperuricemia: insights from a community-based study. Front Med 2019; 13(6): 741–6. doi: 10.1007/s11684-017-0579-7.
- Yang T, Ding X, Wang YL, Zeng C, Wei J, Li H, et al. Association between high-sensitivity C-reactive protein and hyperuricemia. Rheumatol Int 2016; 36(4): 561–6. doi: 10.1007/s00296-016-3429-z.
- Sun SZ, Flickinger BD, Williamson-Hughes PS, Empie MW. Lack of association between dietary fructose and hyperuricemia risk in adults. Nutr Metab (Lond) 2010; 7: 16. doi: 10.1186/1743-7075-7-16.
- Kanbara A, Miura Y, Hyogo H, Chayama K, Seyama I. Effect of urine pH changed by dietary intervention on uric acid clearance mechanism of pH-dependent excretion of urinary uric acid. Nutr J 2012; 11: 39. doi: 10.1186/1475-2891-11-39.
- Thompson FE, Subar AF. Dietary assessment methodology. Nutrition in the prevention & treatment of disease. Salt Lake City: Academic Press; 2013.
Authors retain copyright of their work, with first publication rights granted to SNF Swedish Nutrition Foundation. Read the full Copyright- and Licensing Statement.