Consumo de alimentos ultraprocessados e adesão à Dietary Approaches to Stop Hypertension e níveis de ácido úrico, prevalência e incidência de hiperuricemia em participantes do ELSA-Brasil

Abstract

Introduction: Food can influence both the production and excretion of uric acid, altering serum uric acid (SUA) level and contributing to hyperuricemia (HU). However, because they have complex structures, the same food with different physical and chemical structures can present divergent effects. Also, the various nutrients and non-nutrients combinations interact it selves and may have synergistic effects. Thus, the isolated analysis of the food or nutrient is insufficient to explain the effect of food in the prevention of high SUA level and HU. Objective: To evaluate the association between the consumption of ultra-processed foods (UPFs) and adherence to Dietary Approaches to Stop Hypertension (DASH) and the SUA level, and prevalence and cumulative incidence of HU. Methods: The Longitudinal Study of Adult Health (ELSA-Brasil) follows 15,105 active and retired public servants, of both sexes, aged between 35 and 74 years at baseline (2008-2010). In this study, data up to the 3rd follow-up visit (2008-2010, 2012-2014, and 2016-2018) were used. Participants with complete data on dietary intake and SUA level measured at baseline and at least one follow-up visit were included in the analyses. Individuals with a glomerular filtration rate <60mL/min/1.73m2, bariatric surgery, implausible caloric intake and use of urate lowering therapy at baseline were excluded. HU was defined as SUA≥ 6.8mg/dL. UPFs were classified by NOVA. DASH was classified containing 8 components. Multiple models were used to assess the association between consumption of UPFs, measured every 100 g/day, and adherence of DASH (three level adherence) and SUA/HU. Adjustments for potential confounders were also performed using the Directed Acyclic Graph. The following hypotheses were considered: (1) higher consumption of UPFs is associated with higher SUA level and the prevalence of HU at baseline, in addition to being associated with the cumulative incidence of HU and the acceleration of SUA level change after 3.8 years of follow-up; (2) greater adherence to DASH predicts change in serum SUA level trajectory after 8.1 years of follow-up. Results: Higher UPFs consumption was associated with a higher SUA level (β:0.024, 95%CI:0.016 -0.032), and a 2.4% increase in the chance of HU prevalent (OR: 1.024, 95%CI:1.006 - 1.044) and 5.8% in the cumulative incidence of HU (OR:1.058, 95%CI:1.024 -1.094). The higher consumption of UPFs did not contribute to the acceleration of the increase in SUA level after 3.8 years of follow-up. Medium and high adherence to DASH increased AU level reduction (p-value ≤0.001), and high adherence to the DASH diet decreased the risk of cumulative incidence of HU by 44.5% (OR: 0.555; 95% CI: 0.409; 0.755) compared to low adherence to the DASH diet. Conclusion: The present study adds to the deleterious effects of UPFs consumption, higher SUA level and higher risk of HU. In addition, it shows the beneficial effects of greater adherence to DASH in positively contributing to the reduction of the SUA level and HU after 8.1 years of follow-up.