Association Between the Korean Healthy Eating Index and Hyperuricemia Among Korean Adults

Hyperuricemia is an emerging public health concern associated with gout and metabolic diseases. While numerous studies have examined associations between individual dietary factors and hyperuricemia, comprehensive assessments of overall diet quality and their impact on hyperuricemia are lacking. This study aimed to investigate the association between overall diet quality, as measured by the Korean Healthy Eating Index (KHEI), and the prevalence of hyperuricemia among Korean adults using nationally representative data.

We analyzed data from 27,149 Korean adults aged ≥ 20 years from the Korea National Health and Nutrition Examination Survey (2016-2021). The KHEI assesses dietary quality based on adherence to Korean dietary guidelines, encompassing adequacy, moderation, and balance of intake. Hyperuricemia was defined as serum uric acid ≥ 7.0 mg/dL in men and ≥ 6.0 mg/dL in women. Logistic regression was performed, adjusting for sociodemographic, lifestyle, and health-related factors.

Higher total KHEI scores were significantly associated with a lower prevalence of hyperuricemia (10.6% vs. 15.5%; P < 0.001). After adjustment, participants with high KHEI scores exhibited 22% lower odds of hyperuricemia compared to those with low scores (odds ratio, 0.78; 95% confidence interval, 0.72-0.84). Specifically, higher consumption of breakfast, whole grains, fruits, vegetables, and balanced energy intake were inversely associated with hyperuricemia risk. However, higher intake of purine-rich foods (meat, fish, eggs, beans) was positively associated with hyperuricemia. An unexpected finding was observed regarding sodium: lower sodium intake correlated with increased hyperuricemia risk, possibly related to renal uric acid reabsorption mechanisms or confounding by medications.

Our findings demonstrate a significant inverse relationship between overall dietary quality, assessed using the KHEI, and hyperuricemia risk among Korean adults. The results emphasize the protective effects of balanced dietary habits, highlighting the benefits of regular breakfast consumption, increased fruit and vegetable intake, and balanced energy distribution. These insights underscore the importance of adopting holistic dietary strategies for the prevention and management of hyperuricemia, moving beyond traditional recommendations focused on individual nutrients. Further longitudinal studies are required to clarify causality and mechanisms underlying these associations.