Dietary intake and hyperuricemia among US adults: A matched case-control analysis of NHANES 2001-2020

Hyperuricemia, a chronic metabolic condition characterized by elevated serum uric acid levels, is a major risk factor for gout and has also been associated with cardiovascular disease, hypertension, chronic kidney disease, and metabolic syndrome. Although diet is widely recognized as an important modifiable factor in hyperuricemia, the associations between specific food groups and hyperuricemia remain incompletely understood. In this frequency-matched case-control analysis using data from the National Health and Nutrition Examination Survey 2001-2020, we included 886 individuals with hyperuricemia and 2171 matched controls. Dietary intake was assessed using 24-hour dietary recall data. Unconditional multivariable logistic regression models were applied to examine the associations between food group intake and hyperuricemia, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by comparing the highest with the lowest intake quantiles. False discovery rate-adjusted P for trend values were additionally calculated to account for multiple comparisons. Higher intake of legumes, nuts, and seeds (OR, 0.74; 95% CI, 0.57-0.96), grain products (OR, 0.78; 95% CI, 0.62-0.96), whole-wheat bread, oats, and brown rice (OR, 0.76; 95% CI, 0.62-0.93), eggs (OR, 0.85; 95% CI, 0.77-0.94), and milk products (OR, 0.64; 95% CI, 0.51-0.79) were associated with lower odds of hyperuricemia. In contrast, higher intake of meat, poultry, and fish (OR, 1.22; 95% CI, 1.12-1.33), fish and seafood (OR, 1.09; 95% CI, 1.01-1.23), sugars, sweets, and beverages (OR, 1.60; 95% CI, 1.28-2.00), soft drinks (OR, 1.11; 95% CI, 1.03-1.21), sugar-sweetened soft drinks (OR, 1.13; 95% CI, 1.03-1.23), and sugar-sweetened tea (OR, 1.86; 95% CI, 1.11-3.12) were associated with higher odds of hyperuricemia. The overall directions of the observed associations were largely unchanged after false discovery rate adjustment, although fewer trend tests remained statistically significant. Several dietary factors were associated with hyperuricemia in this National Health and Nutrition Examination Survey-based frequency-matched case-control analysis. These findings may help inform dietary strategies for the prevention and management of hyperuricemia. However, the observed associations should be interpreted cautiously, particularly in light of multiple-comparison adjustment, and further studies are warranted to confirm the findings and clarify their clinical implications.