Body Mass Index Modulates the Relationship Between Sugar-Sweetened Beverage Intake and Serum Urate Concentration

Nicola Dalbeth¹, Amanda Phipps-Green², Meaghan House¹, Gregory Gamble¹, Anne Horne¹, Lisa K. Stamp³ and Tony R. Merriman^2,4, ¹Department of Medicine, University of Auckland, Auckland, New Zealand, ²University of Otago, Dunedin, New Zealand, ³Medicine, University of Otago, Christchurch, Christchurch, New Zealand, ⁴Biochemistry Dept, PO Box 56, University of Otago, Dunedin, New Zealand

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: gout, obesity and uric acid

Session Information

Date: Tuesday, November 10, 2015

Title: Epidemiology and Public Health Poster III (ACR): Gout and Non-Inflammatory Musculoskeletal Conditions

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:
Elevated
body mass index (BMI) and intake of sugar-sweetened beverages (SSB) are both modifiable
risk factors for hyperuricaemia and gout. BMI can modulate the influence of non-modifiable
genetic variants on serum urate. The influence of BMI may also modulate
associations between modifiable factors, such as SSB intake, and serum urate.
The aim of this study was to determine whether the association between SSB intake
and serum urate is moderated by BMI.

Methods:
The
effects of chronic SSB intake on serum urate were assessed in a cross-sectional
study of 12,870 people without
gout from the Atherosclerosis Risk in Communities (ARIC), Framingham Heart
Study (FHS) and New Zealand datasets. The effects of an acute fructose load on
serum urate and fractional excretion of uric acid (FEUA) were examined over 180
minutes in a short-term intervention study. In both analyses, the responses
were compared in those with BMI <25mg/kg² (low BMI) and ≥25mg/kg²
(high BMI).

Results:
In
the cross-sectional study, increased chronic SSB intake was associated with
higher serum urate in the entire group (compared with no intake, BMI-adjusted
P=0.048 for low SSB intake and P=1.1×10^-4 for high SSB intake)
(Table). There was no association between SSB intake and serum urate within
the low BMI group. In contrast, increased SSB intake was associated with
higher serum urate in the high BMI group (P=3.9×10^-4 for low SSB intake
and P=5.3×10^-7 for high SSB intake). The difference in serum urate between
the SSB categories was significantly greater in the high BMI group than in the
low BMI group (P_{BMI group}=0.005). The difference in serum urate was
higher in the high BMI group for both low SSB intake (P_{BMI group}=0.002)
and high SSB intake (P_{BMI group}=0.001). In the acute fructose
loading study, serum urate was increased in the high BMI group at baseline and
throughout the observation period (P_{BMI group}<0.0001), but there
were similar serum urate changes in both BMI groups in response to the fructose
load (P_interaction=0.99). The baseline FEUA was similar between
the two BMI groups. However, following the fructose load, FEUA responses in the
BMI groups differed (P_interaction<0.0001), with increased FEUA at
120 minutes and 180 minutes in the low BMI group and reduced FEUA at 60 minutes
in the high BMI group.

Conclusion:
BMI modulates serum urate responses to chronic sugar-sweetened beverage intake
and renal tubular uric acid handling in response to an acute fructose load. In
addition to other health benefits, avoidance of sugar-sweetened beverages may
be particularly important in those with overweight/obesity to prevent
hyperuricaemia and reduce gout risk.

Table.
Difference in serum urate for chronic sugar-sweetened beverage intake
stratified by BMI group. The difference in serum urate in the overall SSB category
is the average difference from sugar-sweetened beverage category 1 to category
2 to category 3 (i.e. 0, to >0 to <2, to ≥2).

		Per SSB Category		Overall SSB Category
	SSB drinks/day	Difference in serum urate, 95% CI (mmol/L)	P compared with referent group (0 SSB drinks/day)	Difference in serum urate, 95% CI (mmol/L)	P	P comparing BMI < 25 & ≥25
All participants (n=12,127)*	0	–	–	0.005 (0.003-0.007)	4.0×10^-5	–
	>0 to <2	0.004 (0.000-0.008)	0.048
	>2	0.009 (0.005-0.014)	1.1×10^-4
BMI < 25 (n=4,748)	0	–	–	0.001 (-0.002-0.005)	0.494	0.005
	>0 to <2	-0.003 (-0.009-0.003)†	0.36
	>2	0.001 (-0.006-0.008)††	0.80
BMI ≥25 (n=7,379)	0	–	–	0.008 (0.005-0.011)	9.3×10^-7
	>0 to <2	0.011 (0.005-0.016)†	3.9×10^-4
	>2	0.017 (0.010-0.023)††	5.3×10^-7
All analysis adjusted by sample set, age, sex, fruit intake (continuous variable), kidney disease, hypertension, relatedness. *analysis adjusted by BMI. † P_difference between BMI groups =0.002, †† P_difference between BMI groups=0.001

Disclosure: N. Dalbeth, None; A. Phipps-Green, None; M. House, None; G. Gamble, None; A. Horne, None; L. K. Stamp, None; T. R. Merriman, None.

To cite this abstract in AMA style:

Dalbeth N, Phipps-Green A, House M, Gamble G, Horne A, Stamp LK, Merriman TR. Body Mass Index Modulates the Relationship Between Sugar-Sweetened Beverage Intake and Serum Urate Concentration [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/body-mass-index-modulates-the-relationship-between-sugar-sweetened-beverage-intake-and-serum-urate-concentration/. Accessed .

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