Differences in the Association Between Alcoholic Beverage Type and Serum Urate Levels Using Standardized Ethanol Content

Abstract

ImportanceDifferences have been observed in the association of serum urate levels with consumption of different types of alcoholic beverages. However, previous studies have not standardized the unit of intake for ethanol content, and only limited types of alcoholic beverages have been evaluated.ObjectiveTo examine differences in the association of serum urate levels with various types of alcoholic beverages when their intakes are standardized for ethanol content.Design, Setting, and ParticipantsThis retrospective cross-sectional study was conducted using data from participants aged 20 years or older who completed a medical checkup at St Luke’s International University in Japan between October 1, 2012, and October 31, 2021. Participant demographics, blood test results, and lifestyle questionnaire data were used as covariates. Analysis was performed in December 2021.ExposuresConsumption of alcoholic beverages, including beer, sake (rice wine), shochu (Japanese spirit), wine, and whiskey.Main Outcomes and MeasuresSerum urate levels were measured during the medical checkup. The beverage unit was standardized to 1 standard drink, which contained 20 g of ethanol. Multivariable linear regression including interaction terms of alcohol consumption and dominant alcoholic beverage was performed.ResultsThis study included 78 153 participants. Their mean (SD) age was 47.6 (12.8) years; 36 463 (46.7%) were men and 41 690 were women (53.3%). A total of 45 755 participants (58.5%) were regular alcohol drinkers. Consistent associations of serum urate levels with alcohol consumption were observed in the beer-dominant group, with β coefficients (for 1 standard drink per day) of 0.14 mg/dL (95% CI, 0.11-0.17 mg/dL; P < .001) for men and 0.23 mg/dL (95% CI, 0.20-0.26 mg/dL; P < .001) for women. A moderate increase in serum urate levels was observed in the wine-dominant group compared with a modest and nonsignificant increase in the sake-dominant group, with β coefficients (for 1 standard drink per day) for the latter group of 0.05 mg/dL (95% CI, −0.01 to 0.10; P = .10) for men and 0.04 mg/dL (95% CI, −0.05 to 0.14 mg/dL; P = .38) for women. Restricted cubic splines showed different patterns in associations of serum urate levels with ethanol intake by dominant alcoholic beverages.Conclusions and RelevanceThe results of this study suggest that the extent of the association of serum urate levels with alcohol intake was different for alcoholic beverages even after ethanol content was standardized. Higher beer consumption among men and women was consistently associated with higher serum urate levels, whereas sake was not associated with changes in serum urate levels. Therefore, alcoholic beverage type, in addition to ethanol content, should be considered as a factor contributing to hyperuricemia.

Interaction of genetic variation at ADH1B and MLXIPL with alcohol consumption for elevated serum urate level and gout among people of European ethnicity

“…This differs from other studies which found no significant difference between sexes [ 2 , 20 ] or significant effects in males but an absence of effect among females [ 21 , 22 ]. Consistent with previous studies, beer intake was associated with the largest increase in serum urate level and gout, followed by spirits [ 2 – 4 , 20 , 23 , 24 ]. While moderate wine intake did not associate with serum urate or gout in several earlier studies [ 2 – 4 , 20 ], we demonstrated significant association of wine consumption with increased serum urate level among all groups and with gout among men.…”

Changes in alcohol intake and serum urate changes: longitudinal analyses of annual medical examination database

“…Various factors contributed to the extent of the association between alcohol change and SU change. As with previous studies,10 11 13–15 beer intake was most strongly associated with SU level changes in this study. Beer includes more purine bodies compared with other alcohols 32.…”

“…Previous cross-sectional studies have demonstrated the associations of alcohol intake with SU level 10–16. The association between one daily beer intake and SU varied depending on studies but ranged up to 0.5 mg/dL (online supplemental table 4).…”

“…Beer has consistently shown the largest association with SU among alcoholic beverages. One unit increase in daily beer intake was associated with up to 0.5 mg/dL increase in SU level 10–16. This association forms a part of the rationale for recommending alcohol reduction in gout and/or hyperuricemic patients 17 18.…”

“…Cross-sectional epidemiologic studies have shown a direct relationship between alcohol intake and SU level,10–16 such that alcohol intake has the strongest association with SU level among dietary factors 16. Beer has consistently shown the largest association with SU among alcoholic beverages.…”