Population Impact Attributable to Modifiable Risk Factors for Hyperuricemia

Abstract

To examine modifiable risk factors in relation to the presence of hyperuricemia and estimate the proportion of hyperuricemia cases that could be prevented through risk factor modification in the general population compared with estimates of the variance explained. Using data from 14,624 adults representative of the non-institutionalized civilian US population, we calculated adjusted prevalence ratios for hyperuricemia, population attributable risks (PAR), and the variance explained according to the following four factors: body mass index (BMI ≥25 kg/m 2 ), alcohol intake, non-adherence to a DASH-style diet, and diuretic use. BMI, alcohol intake, adherence to a DASH-style diet, and diuretic use were all associated with serum urate levels and the presence of hyperuricemia in a dose-response manner. The corresponding PARs of hyperuricemia cases for overweight/obesity (prevalence, 60%), non-adherence to a DASH-style diet (prevalence, 82%), alcohol use (prevalence, 48%), and diuretic use (prevalence, 8%) were 44% (95% CI, 41 to 48%), 9% (3% to 16%), 8% (5% to 11%), and 12% (11% to 14%), respectively, whereas the corresponding variances explained were 8.9%, 0.1%, 0.5%, and 5.0%. Our simulation study showed the variance nearing zero with exposure prevalence’s nearing 100%. In these nationally representative US adults, four modifiable risk factors (BMI, the DASH diet, alcohol use, and diuretic use) could individually account for a notable proportion of hyperuricemia cases. However, the corresponding serum urate variance explained by these risk factors was very small and paradoxically masked their high prevalences, providing real-life empirical evidence for its limitations in assessing common risk factors.