From plateau to plains: unraveling the diet-exercise paradox in uric acid homeostasis through a comprehensive...

To examine differences in serum uric acid (SUA) concentrations and hyperuricemia prevalence between residents of high- versus low-altitude regions, and determine the major contributing factors to such variations, we conducted a comparative study to investigate the prevalence and influencing factors of individuals living in the Qinghai-Tibet Plateau and low-altitude areas from two time periods.

In this comparative cross-sectional study, individuals living in the Qinghai-Tibet Plateau (101 individuals) and low-altitude areas (502 individuals) from two periods (March to August 2021 and March to August 2022) were recruited to participate and complete questionnaires assessing anthropometric measurements (BMI), physical activity levels, smoking and alcohol consumption habits, and dietary preferences.

Individuals living in high-altitude areas had significantly higher rate of high uric acid levels, accounting for 56.43%, comparing to those living in low-altitude areas alone (5.38%). Our results demonstrated that excessive intake of urate-producing foods, which may lead to overweight and obesity, and inability to eliminate the uric acid produced through exercise may be one of the important reasons for the higher proportion of mechanically ventilated patients in plateau areas. Factors of body mass index, night snacks, beans, and smoking have significant effects on uric acid levels when comparing individuals living in high- and low-altitude areas.

This study identifies significant altitude-dependent variations in SUA regulation, primarily mediated through dietary patterns and energy metabolism. The protective factors observed at high altitudes, such as restricted purine intake and increased physical activity, offer valuable epidemiological evidence for developing targeted prevention strategies against hyperuricemia in low-altitude populations. Key Points • High-altitude residents exhibited 10.5-fold higher hyperuricemia prevalence than low-altitude counterparts (56.43% vs. 5.38%, p < 0.001), revealing profound environmental modulation of uric acid metabolism. Excessive intake of high-purine foods coupled with insufficient energy metabolism due to physical inactivity may contribute significantly to the high prevalence of hyperuricemia in low-altitude regions. • The findings offer robust epidemiological evidence to support the development of targeted prevention strategies for hyperuricemia in low-altitude region.