Study On Multiple-viamins Intervention Of Asymptomatic Hyperuricemia In Xinjiang Uyghur And Han Etinicity

Objectives:This project conducted asymptomatic hyperuricemia in Xinjiang Uyghur and Hansubjects to investigate dietary quality, analyze dietary pattern, deduce the dietary riskfactors and check the metabolic level of vitamins. Moreover, double blindnessintervention of multiple vitamins was conducted to observe the SUA level effect ofdietary vitamin supplementation in hyperuricemia and analyze the index of oxidativestress, insulin resistance, inflammatory factors and adipocyte factors. This work willpreliminary study the effect mechanism of SUA level after vitamins intervention andelucidate further the pathogenesis of hyperuricemia and provide a more economic,effectively and less side effect approaches to control hyperuricemia from the nutritionalview.Methods:Based on hyperuricemia diagnosis criteria confirmed by China Doctors Association,204Uyghur and Han cases with confirmed asymptomatic hyperuricemia from the FirstAffiliated Hospital and Affiliated TCM Hospital of Xinjiang Medical University and204controls were frequency matched on age, gender and area of residence. Factor analysiswas conducted by using dietary information from a validated food frequencyquestionnaire to derive dietary behavior and nutritional status. DBI index and factorsanalysis were combined with traditional dietary nutrients analysis approach to analyzethe dietary quality, pattern and risk factors. General health index and biochemical indexwere checked. HPLC and ELISA were performed to check the serum level of vitamin A、 D、E、B1、B2and C. The difference of dietary and serum vitamins level were comparedin patients and controls groups and in Uyghur and Han populations. Association analysisand non-conditional multiple factors Logistic regression was performed to evaluate theeffect of general index, biochemical index, diet habits, nutrients and serum vitamins levelto asymptomatic hyperuricemia. Cases with confirmed asymptomatic hyperuricemia wereseparated randomly into intervention and control groups.4weeks of multiple vitaminsintervention later, the change of antioxidase, lipid peroxidation, fasting insulin, fastingblood glucose, insulin resistance index, inflammatory factors (TNF–α、IL-6and CRP)and adipocyte factors (Leptin，APN and Resistin) were checked. T test was performed toevaluate the effect of multiple vitamins intervention to the levels of UA, blood lipid,oxidative stress, insulin resistance, inflammatory factors and adipocyte factors inasymptomatic hyperuricemia.Results:(1) Diet habits, dietary nutrients, quality and patterns of hyperuricemia in Uyghurand Han populations:1) Diet behavior: the proportion of smokers, alcohol drinker, tea drinker andphysical trainer were31.9%,45.6%,41.1%and23.2%respectively in hyperuricemiapatients group. The constituent ratio of smokers and alcohol drinker in patients groupwere significantly higher than those of control group. Smoker in Han population wassignificantly higher than that in Uyghur.2) Daily dietary nutrients intake level: intake of daily dietary energy, protein, lipid,carbohydrate, cholesterol, Na, retinol equivalent, vitamin E and thiamin weresignificantly higher in patients group than those in control group. But intake of dietaryfiber and vitamin C were significantly lower in patients group than those in control group.Compare with DRIS, intake of daily protein, Fe, Na and nicotinic acid were excessivewhile heat, vitamin C intake level normal. In addition, intake of retinol equivalent andthiamin were insufficient and Ca, Zn, Se, lactoflavin and vitamin C were lack. Intakelevel of daily dietary heat, lipid, carbohydrate, Na, vitamin E and lactoflavin were highersignificantly while the intake of dietary fiber, Fe, Se, retinol equivalent and vitamin Cwere significantly lower in Uyghur patients group than those in Han ethnic.3) Constitution and resource of dietary energy nutrients: from the view of energyconstituent ratio in hyperuricemia, the energy providing percentage of protein and lipidwere15%and32%respectively. It was higher than12%and28.4%of national average level and12%and25%from DRIs. From the view of food protein resource, proportionof animal protein was much higher than bean protein. From the view of food lipidresource, proportion of animal lipid was higher than plant lipid. Energy provided fromlipid and animal lipid resource were higher while lower of bean protein in Uyghur thanthose in Han population.4) Daily food intake: intake amount of cereal, milk, beans, livestock and poultrymeat, salt, oil and alcohol were significantly higher while lower of vegetables and fruitsin patients group than those in control group. Intake amount of vegetables, beans,fisheries and eggs were significantly higher while lower of milk, livestock and poultrymeat, salt and oil in Han than those in Uyghur population.5) Dietary quality assessment from DBI: DBI score in hyperuricemia and controlgroup were-6.59and-8.19respectively. It demonstrated the insufficient of food diversity,daily milk and beans intake and excess of cereal, livestock and poultry meat, oil andalcohol intake. DBI-LBS、DBI-HBS、DBI-DQB were higher significantly in patientsgroup than those in control group. The higher UA level was, the score of DBI-LBS、DBI-HBS、DBI-DQB were higher. The most common dietary pattern in patients andcontrol groups were pattern B and E. DBI total score, DBI-LBS、DBI-HBS andDBI-DQB were higher in Uyghur than Han population. Constituent ratio with pattern A,B, C and E in Han population were higher than that in Uyghur while pattern D, F and Gwere higher in Uyghur population.6) Dietary quality assessment from factors analysis: there were three factors ordietary pattern whose characteristic root was more than1.5. According to their denotation,three dietary pattern were classified into factor1(18.40%), factor2(10.87%) and factor3(8.8%). Wheat flour and meat, meat and alcohol as well as white meat, eggs, vegetableand fruit were main of dietary pattern in factor1(pattern1),2(pattern2) and3(pattern3)respectively. Single factor logistic regression analysis showed that the OR value of threedietary pattern were2.23,1.40and0.52. Unchangeable result showed after adjusting thevariable of ethnic, age, gender, BMI and energy in multiple factors logistic regressionanalysis.7) Dietary nutrients risk factor analysis: multiple factors logistic regression analysisresult demonstrated that lipid, vitamin C, TG, WC and FINS were related withhyperuricemia. Vitamin C was protective factor, lipid, TG, WC and FINS were riskfactors. Their OR value were0.989,1.871,1.423,1.040and1.017respectively.(2) Relationship between serum vitamin level and UA of hyperuricemia in Uyghur and Han populations and national heterogeneity:1) Comparison between patients group and control group: serum level of retinol andB1were significantly increased while vitamin C and25(OH)D were significantlydecreased. Serum retinol and vitamins level of B1and B2increased following the increaseof UA level. Serum level of25(OH)D increased firstly while decreased after it reached toSUA-4level.2) Comparison between Uyghur and Han populations: serum retinol and vitamin B1level were significantly higher while vitamin E was lower significantly in Uyghur thanthose in Han population. Serum retinol level in patient group showed the ethnicheterogeneity obviously.3) Comparison between men and women: serum retinol and vitamins level of D, E,B1, B2and C were significantly higher in men than those in women. Serum vitamin B1level in patient group showed the ethnic heterogeneity obviously.4) Comparison among different ages: there were significantly different of serumvitamin B1level among different age control groups. Serum vitamin B1level decreasedgradually with growth from30to70.5) Assessment of vitamin status: the proportion difference of retinol excess and25(OH)D, C lack were significant in patient and control groups. Patients group washigher than control group. In control group, the proportion of retinol lack was lower inUyghur than that in Han population. In patients group, the proportion difference ofvitamin lack disappeared. Proportion of retinol, D and C lack was higher in women thanthose in men.6) Correlation analysis between serum vitamins level and UA level: in Hanpopulation, there was a positive correlation between UA level and serum retinol, B1andB2, the correlation coefficient were0.405,0.341and0.370. In Uyghur population, therewas a positive correlation between UA level and serum retinol and vitamin B1, thecorrelation coefficient were0.217and0.185. Moreover, there was a negative correlationbetween UA level and serum vitamin C, the correlation coefficient was0.188. There wasa positive correlation in men between UA level and serum retinol and vitamin B1, thecorrelation coefficient were0.176and0.179. Moreover, there was a negative correlationbetween UA level and serum25(OH)D and C, the correlation coefficient was0.148and0.175. There was a positive correlation in women between UA level and serum retinol,vitamin D, E and B1, the correlation coefficient were0.350,0.186,0.175and0.313. Afterfixing the ethnic and gender, the result of partial correlation analysis demonstrated positive correlation between UA level and retinol, vitamin B1and B2, the correlationcoefficient were0.277,0.244and0.151.7) Risk factors analysis: regression analysis result indicated that retinol and vitaminB1were risk factors of hyperuricemia, OR values were1.013and1.015. Vitamin C and Ewere protective factors, OR values were0.718and0.664respective.(3) Multiple vitamins intervention effect in hyperuricemia of Uyghur and Hanpopulations: relationship between serum vitamin level and UA and national heterogeneity:4weeks of multiple vitamins intervention later.1) UA level: UA level reduced2.27μmol/L in intervention group and there weresignificant difference in Uyghur and Han ethnics.2) Blood lipid level: the concentration of TC and LDL decreased significantly inintervention group than those in control group.3) Carbohydrate metabolism: FINS and HOMA-IR level reduced significantly inintervention group than those in control group and they reduced significantly in Uyghurand Han ethnics.4) Oxidative stress: activity of enzymes SOD and GSH-PX increased significantlyin intervention group than those in control group. The trend of antioxidase and lipidperoxidation in Uyghur and Han intervention group were uniform.5) Inflammatory factors: TNF–α and IL-6reduced significantly in interventiongroup than those in control group. The trend of inflammatory factors in Uyghur and Hanintervention group were uniform.6) Adipocyte factors: Leptin and APN level increased significantly in interventiongroup than those in control group. Only APN level increased significantly in Uyghurintervention group after ethnic stratified.Conclusions:(1) Daily dietary nutrients intake is unbalance. Intake of protein, cholesterol, Fe andNa are excess, insufficient intake of thiamine and lack of lactoflavin, vitamin C, Ca, Zn,Se intake in hyperuricemia. High proportion of animal protein and lipid and lowproportion of bean protein and plant lipid in food resource as well as the intakeinsufficiencies of vegetables, fruits, fisheries, milk and beans and intake excess oflivestock meat, poultry meat, animal viscera, salt and alcohol in dietary structure allindicate severe unbalance of dietary in hyperuricemia. Main factors analysisdemonstrates that wheat flour with animal food pattern (wheat flour, livestock meat, viscera) and animal food with alcohol food pattern (beef and mutton, poultry meat,viscera, eggs and alcohol) are risk factors of hyperuricemia while vegetable, fruit withwhite meat food pattern (poultry meat, eggs, milk, beans products, fruit and vegetable)are protective factors.(2) Daily dietary nutrients intake level, dietary structure and dietary pattern aredifferent in Uyghur and Han ethnics. In Uyghur, intake amount of heat, lipid,carbohydrate, Na, lactoflavin, vitamin and energy provided by lipid are higher whileintake of dietary fiber, vitamin A and C are lower than Han ethnic. The result of DBIdietary quality analysis indicates that the degree of intake insufficiency and lack is higherin Uyghur than those in Han ethnic. Food pattern in patients group of Han and Uyghurethnics tends to high wheat flour with meat and high meat with alcohol respectively.(3) Daily intake of lipid and vitamin C, livestock meat, animal viscera, vegetable,alcohol, TG, WC and FINS are related with hyperuricemia. Among them, vitamin C andvegetable are protective factors while lipid intake, livestock meat, animal viscera, alcohol,TG, WC and FINS are risk factors.(4) Serum vitamin level alters in hyperuricemia. Retinol and B1increase while25(OH)D and vitamin C decrease. Serum retinol and vitamins level of B1and B2increased following the increase of UA level. Retinol, vitamin B1and B2are protectivefactors while vitamin C and E are risk factors. In Uyghur, level of retinol and vitamin B1are higher while level of vitamin E is lower than Han ethnic. Serum vitamins level inmen is higher than that in women. In patient group, the difference of serum vitamins levelin different ethnics and gender are small.(5) UA level reduction after4weeks multiple vitamins intervention relates probablywith improvement of insulin resistance, promotion of antioxidase activity, reduction oflipid peroxidation, regulation of inflammatory factors (TNF-α、IL-6) expression andincrease of APN and Leptin level. Reduction degree of UA level maybe due to shortperiod of intervention.