The situation of increasing serum uric acid, related factors and efficacy of dietary intake in over 30 year of age subjects in rural area of thai binh province

At the same time, the identification of factors related to the scientific basis for the selection of appropriate and specific community interventions.As the theory of increased serum uri

BACKGROUND

Increased serum uric acid (hyperuricemia) is a metabolic disorder that

is closely related to a series of chronic non-infectious diseases such as myocardial infarction, stroke, diabetes, gout This topic has attracted authors interested but new researches just focused on big cities and in hospitals Currently there are no adequate studies in epidemiology increased serum uric acid and prevention in the community Meanwhile, scientific evidence has shown the effectiveness of intervention programs in the community in reducing the risk of death from diseases related to metabolic disorders

Thai Binh is a province in the Northern Delta where there is also a transition of disease patterns Therefore, early detection and control the increase in serum uric acid without clinical manifestations are essential to help reduce the risk of some chronic non-infectious diseases At the same time, the identification of factors related to the scientific basis for the selection of appropriate and specific community interventions.As the theory

of increased serum uric acid with metabolic disorders in rural areas is becoming a significant issue of public health and the consultancy of suitable diet will help control the serum uric acid level, the thesis has been carried out with 3 objectivess as follows:

1 Describing the current status of serum uric acid levels in people at the age of 30 and older in rural community in Thai Binh

2 Identifying factors related to the condition in serum uric acid levels

in the study area

3 Assessing the intervention effects of dietary for people increased serum uric acid in the community

New contributions of the Dissertation

- Giving an abundant database in serum uric acid levels which were analyzed in collaboration with a number of indexes of anthropometry, blood pressure and blood lipids in people over 30 years old in rural communities in Thai Binh It first came up with the rate of increased serum uric acid which was not managed or cared in community, this helped warn a number of groups who often have a high risk of increased serum uric acid including obese and overweight group, big waist, high WHR index, a history of heart disease

- Through multivarible correlation analysis, logistic regression analysis using Bayesian methods the study helped build models to predict serum uric acid levels by age, sex, BMI, abdominal obesity; detect factors independently associated with age, BMI, regular use of red meat, organ meats, bone water, alcohol in males; the independent factors associated with age, BMI, regular use of red meat, organ meats in females

- Proved that "Nutrition communication, counseling for subjects to perform reasonable diet as the sample menu based on the actual diet and locally

available food sources" has been remarkably effective in reducing serum uric acid concentration and reducing serum uric acid levels

Layout of the thesis

The dissertation consists of 130 pages, 30 tables, 12 charts and 153 references including 106 foreign ones Background has 2 pages, 37 page literature review, research methodology 23 pages, 34 page research results, discussion 31 pages, 2 page conclusions and 1 page recommendations

CHAPTER I LITERATURE REVIEW

1 Studies on increased serum uric acid levels

Cohort study follow-up data of Medicine for 50 years showed that if the

1954 -1958 period, the average serum uric acid levels was 5 mg / dl in males and 3,9mg / dl in females, in the 1972 -1976 period, the average level rose 5,7mg / dl in men and 4,7mg / dl in women Australian researches showed that the rate of increased serum uric acid and gout accounted for high percentage compared to some countries in the region with similar economic conditions The rate of increased uric acid increased quickly in 1959 compared with 1980 (17% in men aged 30-40) in the original Australian populations Correspondingly, the incidence of gout increased from 0% in

1965 to 9.7% in men and 2% of women in 2002 Chuang's study evaluated trends in serum uric acid levels in Taiwan adults in two phases from 1993 to

1996 and from 2005 to 2008 showed a different trend Period 1993-1996, average uric acid levels were 6,77mg / dl in males and 5,33mg / dl in females, this value was reduced to 6,59mg / dl in men and 4,97mg / dl in women after 12 years The increased uric acid ratio decreased from 25.3% to 22% in men and from 16.7% to 9.7% in women, respectively This was explained by the change in diet which reduces consumption of organs, fresh bamboo shoots and fresh water use

In Vietnam, the investigation on the subject who were military staff at the middle-aged in 1999, the rate of increased serum uric acid was 17.96% Doan Thi Tuong Vi studied the group which had a periodic health examination at the hospital 19/8, said men aged 30-60 with hyperuricemia was 6.2%, women 2.5%; the overall incidence was 4.9% Related factors were frequency of consumption of foods rich in protein and much alcohol, weight and high BMI The people with increased serum uric acid were at risk for hypertension, cholesterol, serum triglycerides higher than normal Phan Van Hop carried out research in the elderly in Nam Dinh in 2011 showed that the rate of increased serum uric acid was 9.5%, of which 16.3% in male, 5.5% female, group aged 60-90 was10.1%, group aged 70-79 was 9.7% and over 80 years was 8.1% Le Van Doan's research on subjects of middle-aged military officers in the military zone 9 showed the percentage of increased serum uric acid was 26.2%, and the incidence tends to increase with age

Factors related to increased serum uric acid levels were age, high protein diet, hypertension, dyslipidemia, overweight and obesity

2 Factors related to serum uric acid levels

The relevant factors have been reported from domestic and foreign studies included age, male gender, racial factors, genetics and gene mutations, diet, physical activity, nutritional status, puppets hyperlipidemia, hypertension, renal disease, cardiovascular disease and other chronic non-infectious diseases Many studies have identified the clear relationship between the state of increased serum uric acid with a number of non-infectious chronic diseases especially cardiovascular diseases such as heart failure, myocardial infarction, stroke Increased serum uric acid was found in approximately 60% of patients hospitalized with decompensated chronic heart failure Increased serum uric acid linked to insulin resistance status, hypoxic tissue, increases the production of cytokines and free radicals so they could affect the cardiovascular system and prognosis in these patients deteriorate The risk of hypertension also significantly higher in patients with increased serum uric acid of above 400μmol/l compared with those with serum uric acid below 200μmol/l Among patients with untreated hypertension, deterioration phenomenon of coronary artery blood flow in people with increased serum uric acid levels was higher than people with normal serum uric acid A number of studies have given evidence that theere was the combination between increased cholesterol, increased triglycerides and serum uric acid Up to 80% of the triglycerides increased people may increase serum uric acid and up to 50-70% of gout patients have triglycerides increased

3 Intervention methods to decrease serum uric acid

- Use of drugs: In the case of asymptomatic hyperuricemia, drug should be used only when the serum uric acid level is too high, above 12mg / dl (700 μmol / l) or when there is an increase in the level of acute uric acid production The regularly tested cases with hyperuricemia over 10 mg / dl which resists to dietary adjustments, or have a family history of gout, kidney stones with increase serum uric acid, signs of kidney damage are required to take drugs to reduce uric acid

- Control of nutritional status: Many studies have shown that increased serum uric acid is related to obesity, overweight, diabetes, lipid disorders, metabolic syndrome This relationship is in general illness of Insulin resistance syndrome which is essentially due to the excessive accumulation

of fat cells Therefore, to reduce the risk of chronic non-infectious diseases in general, it is necessary to maintain a weight level with ideal body mass index

of 21-23 This is one of 8 independent recommendations of the World Cancer Research Fund and American Institute for Cancer Research published in 2007 A number of studies have recommended, in obese people,

if weight is well controled, it will help reduce serum uric acid similar to implementing a low-purine diet

- Control diet: The increased serum uric acid is closely linked to diet Most uric acid in the body is derived from the metabolism of endogenous purine but diets with purine foods of animal origin may cause increased serum uric acid, because over 50% purine of ARN and 20% of ADN derived from food Therefore, the cases of increased serum uric acid should reduce the consumption of alcohol, soft drinks and fructose, reduce consumption of products of animal origin rich in purines, increase the use of vegetables, fruits, milk and supplement vitamin C

CHAPTER 2 METHODOLOGY 2.1 Study participants

Stage 1: First investigation among people aged 30 and older

Stage 2: Interventional study within 6 months among people with increase in serum uric acid The control group was at 2 communes as Minhkhai and Songlang; the interventional group was at Tanphong and Viethung

2.2 Methodology

2.2.1 Study design

a Stage 1: Cross-sectional descriptive study in order to:

- Describe mean of serum uric acid concentration and increase serum uric acid rate in relation to age group, gender, nutritional situation, level of physical activities

- Identify some factors related to serum uric acid concentration and rate of increase serum uric acid as: gender, age, overweight, obesity, waist circumference, waist-hip ratio, hypertension, high blood glucose, blood lipid metabolic disorders, use of alcohol drink, food consumption

b Stage 2: Community interventional study with control:

People with increase in serum uric acid levels were divided into two groups

of interventional and control groups, we followed up along 6 month period to evaluate the effectiveness of dietary intervention on serum uric acid levels Evaluation results were taken 2 times before and after intervention

Interventions:

Method 1: Mass media on nutrition

Training people with increased serum uric acid content includes general knowledge about the consequences of increased serum uric acid, advice on diet to people with increase in serum uric acid focusing on the selection and use properly of common food sources available locally Organize training in CHCs one time each three months The first time is at the start of the intervention (M0), the second time was at 3 months after conducting research

Compiled communication materials "Community Guidelines for Prevention

of Gout," and each object was distributed this document after the first training

Method 2: Nutrition counseling

We based on dietary habits, dietary practice, based on the source of food and nutrition habits of the local people to build and provide menus for a week, a month participants We developed menus for people with increase in serum uric acid based on nutritional needs for Vietnamese recommended by gender, age, level of physical activity, nutritional status, medical history and based

on actual portions of objects Energy build must ensure a stable weight for people with normal weight, creating cumulative positive energy with the thin and energy reduction with overweight people The menu was based on the principle of reducing the use of protein, especially animal protein, animal protein accounted for approximately 30% The recommended dietary protein level 1g / kg / day and 12-14% to meet energy needs Demand for lipid occupies 20-25% of total energy We performed nutritional counseling 1 time / month for 6 months

Control group: Applying nutritional communication approaches

Intervention group: Apply both nutrition communication approaches and monthly nutritional counseling, as well as dietary building for participants

2.2.2 Sampling procedure and sample size

+ Identify the percentage of increase in serum uric acid and related factors: combining some sampling method, randomly selected 4 communes of Vuthu District and make a list to randomly selected subjects with proper age by R software, sample sizes was as follows:

2

) 2 / 1

(

)(

)1

(

p

p p

2 2 1

2 2

) , (

) (

We calculated the minimum sample size of 68 subjects / 1 group In reality

we has taken all eligible subjects included 77 subjects in intervention group and 72 subjects in control group to participate in the study

2.2.3 Techniques applied to the study

Assessment of nutritional status through BMI, waist circumference, waist/hip circumference Investigation dietary of the last 24 hours, interview to determine the frequency of food consumption, eating habits, medical history, physical examination, blood pressure, blood biochemistry tests

2.2.4 Data processing

Data were analyzed using R software We calculated average value, the ratio, percentage, the statistical test applied in biomedical research to analyze the results Odds ratio OR was calculated to evaluate the factors related to the increase in serum uric acid levels We used multivariate linear regression and

logistic regression to identify associated factors, to exclude of confounding factors and to identify interaction effects The study used a Bayesian method

to select the optimal model for multivariate analysis

2.2.5 Ethical consideration

The study complied with the Declaration of Helsinki of the World Medical Association on ethical issues in Biomedical Research The research proposal was adopted Council Ethics in Biomedical Research at the National Institute

of Hygiene and Epidemiology before conducting research Research ensured the voluntary participation of subjects Safety issues and benefits of the study subjects had been assured during the research process

Chapter III RESULTS 3.1 Situation of increasing in serum uric acid among people aged 30 and older at rural ThaiBinh

Table 3.1 Socio-demographic characteristics of participants

(n=935)

female (n=975)

total (n=1.910)

Table 3.5 Average values and rate of increasing in serum uric acid based

on age group and gender

Table 3.5 showed that average serum uric acid concentrations was 280,9 µmol/l, in which male was 316.1 µmol/l, female was 247.1 µmol/l

Rate of increasing in serum uric acid was 9.2% (95%CI:7.9-10.5%), in

which male was 12% and female was 6.5% Average serum uric acid concentration in male was significant higher than female with p<0,001

Figure 3.3 Increasing in serum uric acid following age group

Result from figure 3.3 showed that serum uric acid increased with age Female had lower rate of increasing uric acid as compared to male However after age of 60, there was an increasing in serum uric acid and they were similar to those among male aged 80 and more

3.2 Factors associated with situation of increase in serum uric acid

Table 3.12 The correlation coefficient between serum uric acid concentration and anthropometry, blood pressure and blood biochemistry

Diastolic blood pressure 0.18 <0.001

Systolic blood pressure 0.16 <0.001

<0.001 We used Bayesian method to select the optimal model to prognostic uric acid levels according to the associated factors Results were 2 models as follows:

1 Uric acid (μmol / l) = 48.7 to 62.2 * gender (1: male, 2 female) + 1.17 * age (years) + 5.9 * BMI (kg / m 2) + 161 , 8 * WHR

2 Uric acid (μmol / l) = 102.7 to 63.2 * gender (1: male, 2 female) + 1.22 * age (years) + 4.92 * BMI (kg / m 2) + 1 , 37 * waist (cm)

Table 3.14 Association between increase in uric acid with age and gender group

<0.05 This risk increased to 2.9 times and 4.5 times in the age group of

70-79 and 80 and older

Table 3 15 Relation between uric acid levels with anthropometric

and 2.8 times higher than the normal group respectively The difference was statistically significant with p <0.001

Table 3.16 Relationship between hyperuricemia with hypertension

in the group level 1 were 1.7 times and 2.3 times increase in group level II respectively The differences are statistically significant at p <0.05 and p

increase

Yes 614 17.6 3.9 (2.8-5.4) <0.001 Triglyceride

than the normal group respectively The difference was statistically significant with p <0.001 The level of HDL-C did not show relation to serum uric acid levels with p> 0.05

Participants with at least one blood lipid disorders had an increased risk of serum uric acid at 3.5 times (95% CI: 2.4 to 5.1) as compared with a group without any lipid disorders

Subjects with metabolic syndrome had an increased risk of serum uric acid at 1.7 times (95% CI: 1.2 to 2.4) as compared with those not suffering from metabolic syndrome The difference was statistically significant with p

Monthly 71 12.7 0.7 (0.3-3.5) >0.05 Weekly 253 13.0 1.8 (1.2-2.7) <0.01 Daily 44 29.5 4.9 (2.5-9.7) <0.001 Table 3.18 showed that smoking group was at risk of high uric acid levels than the non-smokers at 1.5 times The difference was statistically significant with p <0.05 The risk of increasing uric acid increased with the level of using alcohol Group which used alcohol weekly was at increased risk of 2.3 and 1.8 times as compared with groups that did not drink or rarely drink alcohol This risk increased to 2.5 and 4.9 times in participants who used alcohol at daily level respectively

Regularly use of seafood, tofu, beans and soft drink increased uric acid levels compared with not regular use, but the difference was not statistically significant with p> 0.05

Table 3.21 Analysis of multivariate logistic regression between serum uric acid levels and gender

OR (95%CI) p OR (95%CI) p Age (year) 10 2.5 (1.6-3.7) <0.001 1.6(1.2-2.1) <0.01 BMI (kg/m2) 1 2.2 (1.5-3.1) <0.001 3.8(2.6-5.4) <0.001

soup

Yes=1

- 3.9 (2.2-7.1) <0.001

Table 3.21 showed that independent factors related to serum uric acid levels

in men were age, BMI, use of red meat, organ meats, bone soup and use of soft drink regularly In female, we eliminated 2 factors of using alcohol and using bone soup in the analysis as less frequent use of these For each unit of

10 years old would increase the risk of hyperuricemia at 2.5 times in female and 1.6 times in male Increasing one unit of BMI would increase the risk of hyperuricemia to 2.2 times in female and 3.8 times in male

3.3 Effectiveness of dietary to reduce serum uric acid levels

Table 3.23 Effective of dietary to reduce serum uric acid after 6 month intervention