The effect of body weight and alcohol consumption on hyperuricemia and their attributable population fractions: A National health survey in China

Introduction: The prevalence of hyperuricemia is increasing world widely; the understanding of population attributable faction of modifiable risk factors is important for disease prevention. Given the sparse evidence on how modifiable risk factors influence hyperuricemia in mainland China, we aim to explore the effect of excess weight and alcohol consumption and the population attributable fractions of hyperuricemia based on a national survey in mainland China. Methods: Using data from China National Health Survey which included 31746 Han Chinese aged 20-80 from ten provinces, we estimated the prevalence and modifiable risk factors (overweight/obesity and alcohol consumption)of hyperuricemia. Hyperuricemia was defined as serum uric acid > 417 μmol/L in men and > 340 μmol/L in women. Restricted cubic spline models were used to demonstrate the linear and non-linear association between exposures and hyperuricemia. The adjusted population attributable risk (PAR) was calculated to understand the relative importance of each modifiable risk factor. Results: The prevalence of hyperuricemia was 25.1% in men and 15.9% in women. The population fraction of hyperuricemia cases that could be avoided by weight loss was 20.6% (19.2% to 22.0%) in men and 18.1% (17.1% to 19.0%) in women. The PAR of alcohol consumption was 12.8% (8.5% to 17.1%) in men. Participants from southwest China had the highest hyperuricemia prevalence (47.9% in men and 29.9% in women), but with lower PAR of modifiable risk factors, especially in men (16.7%). Subjects in North China had lower hyperuricemia prevalence but higher PAR of modifiable risk factors. 44.8% male hyperuricemia cases in Inner Mongolia (26.9% of hyperuricemia prevalence) and 37.7% cases in men from Heilongjiang (34.4% of hyperuricemia prevalence) were attributable to overweight/obesity and alcohol consumption. Conclusion: There are significant sex and geographic difference on population attributable risk of hyperuricemia due to modifiable risk factors. More tailored prevention strategies are needed to prevent hyperuricemia through weight loss and the reduction of alcohol consumption.