Correlation nutritional status with uric acid level in Minangkabau men ethnicity

INTRODUCTION

Hyperuricemia is a pathological condition that can be modified. Hyperuricemia can cause an increase in cardiovascular disease, hypertension, diabetes, and kidney disease and is a predictor of metabolic syndromes. A decrease in serum uric acid levels can prevent the onset of the disease, one of which is through lifestyle modification.¹

This uric acid level is also influenced by taste or ethnicity and gender. A cohort study conducted by Coley et al, stated that African-American race is associated with higher uric acid levels than Caucasians, and there are no differences between the male and female uric acid.² Likewise with the research of Maynard et al and Singh which stated that the incidence of hyperuricemia was higher in the black race than in white, but in this study men had a higher risk of suffering from hyperuricemia than women.^3,4

Some studies also say that nutritional status is associated with uric acid levels. Lumunon's study on the elderly stated that there was a relationship between nutritional status and the incidence of gout arthritis.⁵

Likewise with Beberashvili's research which states that there is a relationship between nutritional status and uric acid levels.⁶ Improved nutritional status is associated with an increase in body fat. This will cause an increase in the amount of leptin that plays a role in the synthesis and regulation of uric acid in the blood.^7,8

Minangkabau ethnic is a society in West Sumatra that has a diet high in saturated fat and low in vegetables and fruits which are sources of fiber, compared to other ethnic groups in Indonesia.⁹ The prevalence of overweight and obesity in the Minangkabau ethnic group is also quite high. Desmawati's research on Minangkabau ethnicity in Padang city found that 35% of respondents were overweight and obese with a mean BMI of 26,297±4.03kg/m^2,10 This study aims to determine the relationship of nutritional status with Minangkabau ethnic male uric acid levels.

METHODS

This research was a descriptive analytic study by using cross-sectional design. This research was conducted in Padang, west Sumatera in September to October 2016. The sample was taken randomly from all Padang city Government Civil Servants. The number of subjects was 138 people.

Inclusion criteria

• • Male sex,
• • Aged 40-50years
• • And were willing to be research subjects.

Exclusion criteria

• • Subjects who were suffering from fever and infectious diseases,
• • Suffering from severe illnesses such as kidney failure and cancer.
• • Besides that, subjects who could not be found in three visits were also excluded from the study.

The subject was given an explanation of the research and if he was willing to become sample, the subject will sign an informed consent. The participation of subjects in research was voluntary and without coercion of anyone.

Nutritional status was calculated based on height and weight. Height was measured using stature meter and body weight was measured using calibrated scales. Height measurements are done twice by standing up against the wall and the back of the head, shoulders, hips, calves and heels touching the wall. weight measurement was also done twice. Subjects wear thin clothes, do not wear shoes or footwear and do not carry any weight. All the examination done by trained people.

Examination of serum uric acid levels was carried out after subjects fasting for 8-12hours. About 3ml of venous blood taken in the cubital fossa area, was carried out by a trained laboratory officer after the subjects signed informed consent. Uric acid levels were examined at the Prodia Laboratory in Padang city. Data was analyzed by Chi-Square test with a significance level of p <0.05. This research has been approved by the Ethics Committee of Medical Faculty, Andalas University.

RESULTS

This research has been carried out in a cross-sectional design, in male civil servants in sub-districts in Padang city aged 40-50years. The number of samples that meet the research criteria are 140 people. After analyzing all of data, there were 2 subjects whose data was invalid, so they were excluded from the study. The total subjects analyzed were 138 people. All of subject in this study was Minangkabau ethnicity, that means their parent and their grandparent were Minangkabau ethnicity too, and nobody was married with another ethnic (cross ethnicity marriage). Nutritional status stated by Body Mass Index (BMI) that measured based on weight and height examination. Distribution of nutritional status of subject can be seen in below table.

Examination of serum uric acid levels is carried out after subjects fast for 8-12 hours. The average uric acid level of the study subjects was 5.75±1.39mg/dL. Most of the respondent's uric acid levels were within normal limits, but almost a quarter of the subject have hyperuricemia (21%).

Table 1 shows that most subjects was obese, when was calculated as overweight and obese, authors can find that about 65.7% of subject have overweight and obesity. But, still found about 7.3% subject was underweight.

Table 2 depicts that the statistical test results showed that there was a significant relationship between nutritional status and serum uric acid levels of study subjects (p <0.05). subjects who have more nutritional status and obesity have higher uric acid levels than normal nutritional status.

DISCUSSION

The results this study was conducted in all districts in the city of Padang with the number of subjects as many as 138 people. All of subjects was male. This study showed that most of the study subjects had more nutritional status and obesity, even almost 45% classified as obese. This result is higher than Harbuwono’s study that state the prevalence of obesity in the Indonesian adult population is 23.1%.¹¹ Rahmi et al, state that the prevalence of overweight has increased since the early 1990s, with higher prevalence rates in women compared with men.¹²

Obesity is a risk factor for an increase in uric acid levels. In people who are overweight and obese, there is an increase in uric acid mainly due to an increase in body fat. In addition, the body surface area also affects uric acid levels where fat people will produce more gout compared to thin people. In obesity, there is also an increase in uric acid synthesis, but on the other hand, uric acid excretion decreases.¹³

In obesity, there is also a moderate level of oxidative stress, so it requires enough antioxidants to neutralize it.¹⁴ In this study, it was found that antioxidant intake was low in food intake of research subjects. This result is contrary to the results of Nursilmi's research on female elderly in Posbindu Sinarsari. This may be due to the research being carried out on women and most subjects had normal nutritional status.¹⁵

In this study, 21% of subjects suffered from hyperuricemia. Epidemiologically, hyperuricemia is more common in men than in women. Research in China, Japan, Nepal, and Thailand reports that the incidence of increased uric acid is more common in men than in women.^1,16-18 High uric acid levels are also often found in adults compared to adolescents and children.¹⁸

This study done on Minangkabau ethnicity male. Several previous studies say that ethnicity influences the uric acid level. Coley et al, stated that uric acid level was higher in African-American race than Caucasian race.² Others study say that incidence of hyperuricemia was higher in the black race than in white.^3,4 Increased levels of uric acid can be caused by hormonal influences, where estrogen hormones play a role in accelerating uric acid excretion. This hormone does not exist in men. This statement supports the results of previous studies which said that uric acid levels were higher in men than women.^3,4 However, Coley et al. getting different results is that male uric acid levels are no different from women.²

Statistical test results show that there is a significant relationship between nutritional status and serum uric acid levels of study subjects. This study is in line with the study of Akram et al, which states that obesity is associated with hyperuricemia.¹⁹ This study also in line with Lumunon's study on the people above 60years old, that stated there was a relationship between nutritional status and the incidence of gout arthritis.⁵ Likewise with Beberashvili's research which states that there is a relationship between nutritional status and uric acid levels 6. Improved nutritional status is associated with an increase in body fat. This will cause an increase in the amount of leptin that plays a role in the synthesis and regulation of uric acid in the blood.^7,8

Serum uric acid is also a reliable as prediktor of pre-metabolic syndrome. There is no explanation yet how is the mechanism for increasing serum uric acid in obese people, but it has been observed that uric acid is a significant determinant factor of changes in body mass index. Besides that, nutritional status also plays a role in influencing uric acid levels through the role of hyperglycemia and insulin resistance which often occurs in people who have more weight or obesity.^20,21

Another possible cause of increased uric acid levels in the study subjects was a high intake of purine and high fructose. A high purine and high fructose diet play a role in increasing uric acid levels, where purine is the main substrate that forms uric acid. Likewise, with fructose, where one of the results of fructose metabolism is uric acid. More research is needed on this.^13,22,23

CONCLUSION

From the results of this study it can be concluded that the majority of research subjects have a nutritional status of obesity. As many as 21% of subjects suffer from hyperuricemia. There was a significant relationship between nutritional status and serum uric acid levels in Minangkabau ethnic men in Padang City.

ACKNOWLEDGEMENTS

Authors would like to thank all study participants.

Funding: Medical Faculty of Andalas University (DIPA of Andalas University, 2016 Nomor DIPA-042.01.02.400928/2016 and Young Lecturer Grand no. 62/BBPT/PNP/FK-Unand-2016

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Liu B, Wang T, Zhao HN, Yue HN, Yu HP, Liu CX, et al. The Prevalence of hyperuricemia in China: a meta-analysis. BMC Public Health 2011;11:823.
2. 2. Coley K, Saul M, Pater K. Relationship between race, uric acid levels, urate-lowering therapy and resource use in patients with gout. ACR/ARHP Annual Meeting 2012:1816. Available at: https://acrabstracts.org/abstract/relationship-between-race-uric-acid-levels-urate-loweringtherapy-and-resource-use-in-patients-with-gout/
3. 3. Maynard JW, McAdams-DeMarco MA, Law A, Kao L, Gelber AC, Coresh J, et al. Racial differences in gout incidence in a population-based cohort: atherosclerosis risk in communities study. Am J Epidemiol. 2013 Dec 13;179(5):576-83.
4. 4. Singh JA. Racial and gender disparities among patients with gout. Current Rheumatol Reports. 2013 Feb 1;15(2):307.
5. 5. Lumunon OJ, Bidjuni H, Hamel R. Relationship of nutritional status with gout arthritis in elderly at Wawonasa Manado Health Center. E-journal Nursing (e-Kp) 2015;3. Available at: https://ejournal.unsrat.ac.id/index.php/jkp/article/view/8777
6. 6. Beberashvili I, Erlich A, Azar A, Sinuani I, Feldman L, Gorelik O, et al. Longitudinal study of serum uric acid, nutritional status, and mortality in maintenance hemodialysis patients. Clin J Am Soc Nephrol. 2016 Jun 6;11(6):1015-23.
7. 7. Numata T, Miyatake N, Wada J, Makino H. Comparison of serum uric acid levels between Japanese with and without metabolic syndrome. Diab Res Clin Practice. 2008 Apr 1;80(1):e1-5.
8. 8. Yun JE, Kimm H, Jo J, Jee SH. Serum leptin is associated with metabolic syndrome in obese and nonobese Korean populations. Metabolism. 2010 Mar 1;59(3):424-9.
9. 9. Hatma RD. Lipid profiles among diverse ethnic groups in Indonesia. Acta Med Indones. 2011 Jan;43(4).
10. 10. Desmawati. Correlation of anthropometric measurements with blood pressure and plasma angiotensinogen in adults. MKA. 2014;37:1-7.
11. 11. Harbuwono DS, Pramono LA, Yunir E, Subekti I. Obesity and central obesity in Indonesia: evidence from a national health survey. Med J Indonesia. 2018 Sep 9;27(2):114-20.
12. 12. Rachmi CN, Li M, Baur LA. Overweight and obesity in Indonesia: Prevalence and risk factors-A literature review. Public Health. 2017 Jun 1;147:20-9.
13. 13. Hensen PT. Association between purine consumption and hyperuricemia in Balinese people living in tourist village. J Peny Dalam. 2007;8(1):37-43.
14. 14. Susantiningsih T. Obesity and Oxidative Stress. JuKe Unila 2015;5:89-93. Available at: https://www.researchgate.net/publication/51231617_Inflammation_Oxidative_Stress_and_Obesity.
15. 15. Nursilmi N. Relationship between consumption patterns, nutritional status, and physical activity with elderly uric acid levels of women participating in POSBINDU Sinarsari. Essay 2013. Available at: https://repository.ipb.ac.id/jspui/bitstream/123456789/66309/1/I13nur.pdf.
16. 16. Nagahama K, Iseki K, Inoue T, Touma T, Ikemiya Y, Takishita S. Hyperuricemia and cardiovascular risk factor clustering in a screened cohort in Okinawa, Japan. Hypertension Res. 2004;27(4):227-33.
17. 17. Kumar S, Singh AR, Takhelmayum R, Shrestha P, Sinha JN. Prevalence of hyperuricemia in Chitwan District of Nepal. J Coll Med Sci-Nepal. 2010;6(2):18-23.
18. 18. Jularattanaporn V, Krittayaphong R, Boonyasirinant T, Udol K, Udompunurak S. Prevalence of hyperuricemia in Thai patients with acute coronary syndrome. Thai Heart J. 2008;21:86-92.
19. 19. Akram M, Asif HM, Usmanghani K, Akhtar N, Jabeen Q, Madni A, et al. Obesity and the risk of hyperuricemia in Gadap Town, Karachi. Afr J Biotechnol. 2011 Feb 7;10(6):996-8.
20. 20. Fam AG. Gout, diet, and the insulin resistance syndrome. J Rheumatol. 2002 Jul 1;29(7):1350-5.
21. 21. Pacifico L, Cantisani V, Anania C, Bonaiuto E, Martino F, Pascone R, et al. Serum uric acid and its association with metabolic syndrome and carotid atherosclerosis in obese children. Eur J Endocrinol. 2009 Jan 1;160(1):45-52.
22. 22. Tappy L, Lê KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev. 2010 Jan;90(1):23-46.
23. 23. Desmawati. Effect of high fructose intake on blood pressure. MKA. 2017;40:31-9.