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      Sugar-Sweetened Soft Drinks and Fructose Consumption Are Associated with Hyperuricemia: Cross-Sectional Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

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          Abstract

          The secular trend of hyperuricemia coincides with the substantial increase in the consumption of sugar-sweetened beverages. Our aim was to evaluate the association between the consumption of soft drinks, dietary fructose and unsweetened, non-processed fruit juices with hyperuricemia in a cross-sectional analysis of baseline data (2008–2010; n = 7173) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The explanatory variables were the consumption of soft drinks, fruit juice, and fructose using a validated semi-quantitative food frequency questionnaire. The outcomes were hyperuricemia and the uric acid concentration in serum. Regression models were tested, and a significance level of 5% was adopted. In men, the daily consumption of a portion of soft drink/day (250 mL) almost doubled the chance of hyperuricemia with a linear trend. In women, the consumption of ≥0.1 to <1.0 soft drink/day was associated with a higher chance of hyperuricemia, but there was no linear trend. High fructose consumption in men and moderate and high consumption in women were associated with hyperuricemia. All categories of soft drinks consumption were linearly associated with increased serum uric acid levels. Our findings suggest that the consumption of soft drinks and dietary fructose is positively associated with a higher chance of hyperuricemia and higher uric acid levels in Brazilian adults.

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          Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease.

          Currently, we are experiencing an epidemic of cardiorenal disease characterized by increasing rates of obesity, hypertension, the metabolic syndrome, type 2 diabetes, and kidney disease. Whereas excessive caloric intake and physical inactivity are likely important factors driving the obesity epidemic, it is important to consider additional mechanisms. We revisit an old hypothesis that sugar, particularly excessive fructose intake, has a critical role in the epidemic of cardiorenal disease. We also present evidence that the unique ability of fructose to induce an increase in uric acid may be a major mechanism by which fructose can cause cardiorenal disease. Finally, we suggest that high intakes of fructose in African Americans may explain their greater predisposition to develop cardiorenal disease, and we provide a list of testable predictions to evaluate this hypothesis.
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            Metabolic syndrome, diabetes, and hyperuricemia.

            To explore the causal relationship between metabolic syndrome, type 2 diabetes and hyperuricemia. The prevalence of hyperuricemia in male adults with metabolic syndrome was increased and a large difference in prevalence of metabolic syndrome also existed in those with hyperuricemia compared with normouricemia. Even in those with normouricemia, higher serum uric acid levels were associated with metabolic syndrome. Serum uric acid was an independent risk factor for incident diabetes, and evidence showed that the patients with both gout and type 2 diabetes exhibited a mutual inter-dependent effect on higher incidences. Furthermore, obese patients often demonstrated insulin resistance and adipose tissue macrophage with low-grade inflammation, which is suggested to be the major contributor. Although alcohol intake is considered a risk for developing hyperuricemia, moderate alcohol intake showed a lower risk for developing type 2 diabetes and insulin resistance. Hyperinsulinemia reduces renal excretion of uric acid on the proximal tubular of the kidney leading to hyperuricemia, which has deleterious effects on endothelial function and on nitric oxide bioavailability, thus causing hyperinsulinemia. We found evidence to suggest that insulin resistance plays a potentially key role in the causal relationship between metabolic syndrome, type 2 diabetes and hyperuricemia. Furthermore, it is likely that hyperuricemia and insulin resistance share a bidirectional causal effect.
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              Disponibilidade domiciliar de alimentos no Brasil: distribuição e evolução (1974-2003)

              OBJETIVO: Descrever a distribuição da disponibilidade domiciliar de alimentos no Brasil em 2002-2003 e avaliar sua evolução nas áreas metropolitanas do País no período 1974-2003. MÉTODOS: A principal base de dados do estudo é a Pesquisa de Orçamento Familiar de 2002-2003 realizada pelo Instituto Brasileiro de Geografia e Estatística em 48.470 domicílios brasileiros. Em cada domicílio, num período de sete dias consecutivos, foram registradas todas as aquisições, monetárias ou não monetárias, de alimentos e bebidas para consumo familiar. As quantidades de alimentos adquiridas foram transformadas em calorias e macronutrientes, usando tabelas de composição alimentar. RESULTADOS: Características positivas do padrão alimentar, encontradas em todas as regiões e em todas as classes de rendimento, foram a adequação do teor protéico das dietas e o elevado aporte relativo de proteínas de alto valor biológico. Características negativas, também disseminadas no País, foram excesso de açúcar e presença insuficiente de frutas e hortaliças na dieta. Nas regiões economicamente mais desenvolvidas, no meio urbano e entre famílias com maior rendimento houve também excesso de gorduras em geral e de gorduras saturadas. A evolução nas áreas metropolitanas do País evidenciou declínio no consumo de alimentos básicos, como arroz e feijão, aumentos de até 400% no consumo de produtos industrializados, como biscoitos e refrigerantes, persistência do consumo excessivo de açúcar e insuficiente de frutas e hortaliças e aumento no teor da dieta em gorduras em geral e gorduras saturadas. CONCLUSÕES: Padrões e tendências da disponibilidade domiciliar de alimentos no Brasil são consistentes com a importância crescente de doenças crônicas não transmissíveis no perfil de morbi-mortalidade e com o aumento contínuo da prevalência da obesidade no País.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                27 July 2018
                August 2018
                : 10
                : 8
                : 981
                Affiliations
                [1 ]Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória CEP 29042-755, Brazil; jordana.herzog@ 123456gmail.com (J.H.S.); josegmill@ 123456gmail.com (J.G.M.)
                [2 ]Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte CEP 30130-100, Brazil; jguveme@ 123456ufmg.br (G.V.-M.); alexandradm84@ 123456gmail.com (A.D.M.)
                [3 ]Hospital das Clinicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte CEP 30130-100, Brazil; sandhi.barreto@ 123456gmail.com
                [4 ]Clinical and Epidemiological Research Center, University Hospital, University of São Paulo, São Paulo CEP 05508-000, Brazil; isabensenor@ 123456hu.usp.br
                Author notes
                [* ]Correspondence: mdcarmen2007@ 123456gmail.com ; Tel.: +55-27-3335-7146
                Author information
                https://orcid.org/0000-0002-8614-988X
                Article
                nutrients-10-00981
                10.3390/nu10080981
                6116015
                30060512
                e550fff6-bfa4-4d4f-9265-5a0fa01c852a
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 03 July 2018
                : 25 July 2018
                Categories
                Article

                Nutrition & Dietetics
                sugar-sweetened soft drinks intake,fruit and vegetable juices,fructose,uric acid,hyperuricemia

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