Prevalence of hyperuricemia in professional athletes and its role in the genesis of various pathological conditions and metabolic disturbances

In recent decades, the prevalence of hyperuricemia (HU) is increasing worldwide; the role of uric acid (UA) in the genesis of various metabolic disorders, cardiovascular diseases, and kidney disease is being discussed. There are very few investigations of the rate of HU and its role in the development of diseases in certain social groups, including in professional athletes.

Objective: to estimate the prevalence of HU and its role in the genesis of various pathological conditions and metabolic disturbances in professional athletes.

Patients and methods. A retrospective comparative one-stage study was conducted, for which 2148 athletes who met inclusion criteria were selected and examined in the Federal Research and Clinical Center for Sports Medicine and Rehabilitation, Federal Biomedical Agency, in 2015. A control group consisted of 99 ageand sex-matched healthy volunteers examined at the V.A. Nasonova Research Institute of Rheumatology in 2017. The analysis included a comparison of the rate of HU and other examined parameters in professional athletes and healthy volunteers. The examined parameters were separately compared in athletes with/without HU, followed by statistical processing of results.

Results. HU was detected in 306 (14.2%) of the 2148 athletes, more often in men (n=253 (20%) than in women (n=53 (6%); (p<0.001). The rate of HU in the athletes was comparable with that in the healthy population (12.1%). The athletes with HU (n=306) compared with the other athletes (n=1842) had the following statistically higher indicators: the mean serum levels of creatinine, triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidase, creatinine phosphokinase, and myoglobin, glomerular filtration rate, and body mass index (BMI) (p<0.00001 for all cases).

Conclusion. HU is detected quite often in professional athletes (14.2%), which is comparable with the indicators seen in healthy volunteers (12.1%). The high prevalence of HU and its association with indicators reflecting kidney function, lipid metabolic disturbances, and BMI necessitate further investigations aimed at searching the causes of HU and methods of its prevention and treatment in professional athletes.

1. Chen JH, Yeh WT, Chuang SY, et al. Gender-specific risk factors for incident gout: a prospective cohort study. Clin Rheumatol. 2012 Feb;31(2):239-45. doi: 10.1007/s10067011-1802-6. Epub 2011 Jul 15.

2. Conen D, Wietlisbach V, Bovet P, et al. Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country. BMC Public Health. 2004;4:9. Published online 2004 Mar 25.

3. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 20072008. Arthritis Rheum. 2011 Oct;63(10): 3136-41. doi: 10.1002/art.30520.

4. Li Q, Li X, Kwong JS, et al. Diagnosis and treatment for hyperuricaemia and gout: a protocol for a systematic review of clinical practice guidelines and consensus statements. BMJ Open. 2017 Jun 23;7(6):e014928.

5. Yamanaka H. Nucleosides, Nucleotides and Nucleic Acids. Jordan KM Rheumatology (Oxford). 2011 Dec;30(12):1018-29.

6. Nakamura K, Sakurai M, Miura K, et al. Alcohol intake and the risk of hyperuricaemia: a 6-year prospective study in Japanese men. Nutr Metab Cardiovasc Dis. 2012 Nov;22(11): 989-96. doi: 10.1016/j.numecd.2011.01.003. Epub 2011 Mar 21.

7. Choi HK, Curhan G. Beer, liquor, and wine consumption and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2004 Dec 15;51(6):1023-9.

8. Neogi T, Chen C, Niu J, et al. Alcohol quantity and type on risk of recurrent gout attacks: An internet-based case-crossover study Am J Med. Author manuscript; available in PMC 2015 Apr 1. Published in final edited form as: Am J Med. 2014 Apr;127(4): 311-8. Published online 2014 Jan 17.

9. Choi HK, Atkinson K, Karlson EW, et al. Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men. N Engl J Med. 2004 Mar 11;350(11):1093-103.

10. Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005 Jan;52(1):283-9.

11. Zhelyabina OV, Eliseev MS. Diet in gout and hyperuricemia. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2017;55(4):436-45. (In Russ). doi: 10.14412/1995-4484-2017-436-445

12. Eliseev MS, Barskova VG, Denisov IS. Dynamics of clinical manifestations of gout in men (data of 7-year retrospective observation). Terapevticheskii arkhiv. 2015;87(5): 10–5. (In Russ.).

13. Eliseev MS. Chronic kidney disease: the role of hyperuricemia and the possibility of uratelowering therapy. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2018;12(1): 60-5. (In Russ.). doi: 10.14412/1996-70122018-1-60-65

14. Neogi T. Asymptomatic hyperuricemia: cardiovascular and renal complications. In: Terkeltaub R, editor. Gout and other crystal arthropathies. Philadelphia: Elsevier Saunders; 2012. P. 226-38.

15. Rathmann W, Funkhouser E, Dyer AR, Roseman JM. Relations of hyperuricemia with the various components of the insulin resistance syndrome in young black and white adults: the CARDIA study. Coronary Artery Risk Development in Young Adults. Ann Epidemiol. 1998 May;8(4):250-61.

16. Yamanaka H. Japanese Guideline for the Management of Hyperuricemia and Gout: Second Edition. Nucleosides Nucleotides Nucleic Acids. 2011 Dec;30(12):1018-29. doi: 10.1080/15257770.2011.596496.

17. Hidalgo y Teran Elizondo R, Martin Bermudo FM, Penaloza Mendez R, et al. Nutritional intake and nutritional status in elite Mexican teenagers soccer players of different ages. Nutr Hosp. 2015 Oct 1;32(4): 1735-43. doi: 10.3305/nh.2015.32.4.8788.

18. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-421.

19. Palacios G, Pedrero-Chamizo R, Palacios N, et al. Biomarkers of physical activity and exercise. Nutricion Hospitalaria. 2015;(31): 237-44.

20. Kornyakova VV, Konvai VD, Muratov VA. Metabolic disorders of purines in athletes of cyclic sports. Fundamental'nye issledovaniya. 2015;7(3): 468-70. (In Russ.).

21. Hershfield MS, Roberts LJ, Ganson NJ, et al. Treating gout with pegloticase, a PEGylatedurate oxidase, provides insight into the importance of uric acid as an antioxidant in vivo. Proc Natl Acad Sci U S A. 2010 Aug 10;107(32):14351-6. doi: 10.1073/pnas.1001072107. Epub 2010 Jul 26.

22. Lin WL, Yen KT, Chang CK. High prevalence of hyperuricemia in Taiwanese. J Clin Rheumatol. 2006 Jun;12(3):159-60.

23. Bonora E, Targher G, Zenere MB, et al. Relationship of uric acid concentration to cardiovascular risk factors in young men. The role of obesity and central fat distribution. The Verona Young Men Atherosclerosis Risk Factors Study. Int J Obes Relat Metab Disord. 1996 Nov;20(11):975-80.

24. Zavaroni I, Mazza S, Fantuzzi M, et al. Changes in insulin and lipid metabolism in males with asymptomatic hyperuricemia. J Intern Med. 1993 Jul;234(1):25-30.

25. Vuorinen-Markkola H, Yki-Jд rvinen H. Hyperuricemia and insulin resistance. J Clin Endocrinol Metab. 1994 Jan;78(1):25-9.

26. Facchini F, Ida Chen YD, Hollenbeck CB, Reaven GM. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance and plasma uric acid oncentration. JAMA. 1991 Dec 4;266(21):3008-11.

27. Roddy E, Packham J, Obrenovic K, et al. Management of gout by UK rheumatologists: a British Society for Rheumatology national audit. Rheumatology (Oxford). 2018 May 1; 57(5):826-30.

28. Roddy E, Zhang W, Doherty M. The changing epidemiology of gout. Nat Clin Pract Rheumatol. 2007 Aug;3(8):443-9.

29. Li Q, Li X, Kwong JS, et al. Diagnosis and treatment for hyperuricaemia and gout:a protocol for systematic review of clinical practice guidelines and consensus statements. BMJ Open. 2017 Jun 23;7(6):e014928. doi: 10.1136/bmjopen-2016-014928.

30. Sumino H, Ichikawa S, Kanda T, et al. Reduction of serum uric acid by hormone replacement therapy in postmenopausal women with hyperuricaemia. Lancet. 1999 Aug 21;354(9179):650.

31. Harrold LR, Yood R, Mikuls TR, et al. Sex differences in gout epidemiology, evaluation and treatment. Ann Rheum Dis. 2006 Oct;65(10):1368-72. Epub 2006 Apr 27.

32. Eliseev MS, Chikalenkova NA, Denisov IS, Barskova VG. Risk factors for gout: Gender differences. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2011;49(6):28-31. (In Russ.). doi: 10.14412/1995-4484-2011-516

33. Yahyaoui R, Esteva I, Haro-Mora JJ, et al. Effect of long-term administration of cross-sex hormone therapy on serum and urinary uric acid in transsexual persons. J Clin Endocrinol Metab. 2008 Jun;93(6): 2230-3. doi: 10.1210/jc.2007-2467. Epub 2008 Mar 18.

34. You L, Liu A, Wuyun G, et al. Prevalence of hyperuricemia and the relationship between serum uric acid and metabolic syndrome in the Asian Mongolian area. J Atheroscler Thromb. 2014;21(4):355-65. Epub 2014 Jan 7.

35. Banfi G, Del Fabbro M, Lippi G. Serum creatinine concentration and creatininebased estimation of glomerular filtration rate in athletes. Sports Med. 2009;39(4):331-7. doi: 10.2165/00007256-200939040-00005.

36. Barkas F, Elisaf M, Liberopoulos E, et al. Uric acid and incident chronic kidney disease in dyslipidemic individuals. Curr Med ResOpin. 2018 Jul;34(7):1193-1199. doi: 10.1080/03007995.2017.1372157. Epub 2017 Sep 21.

37. Johnson RJ, Nakagawa T, Sanchez-Lozada LG, et al. Sugar, Uric Acid, and the Etiology of Diabetes and Obesity. Diabetes. 2013 Oct;62(10):3307-15. doi: 10.2337/db12-1814.

38. Kornyakova VV, Konvai VD. Acute violation of the purine metabolism as trigger of the development of fatigue in athletes swimmers. Sovremennye problemy nauki i obrazovaniya. 2015;(2):548. (In Russ.).

39. Lombardi G, Colombini A, Ricci C, et al. Serum uric acid in top-level alpine skiers over four consecutive competitive seasons. Clin Chim Acta. 2010 May 2;411(9-10):645-8. doi: 10.1016/j.cca.2010.01.021. Epub 2010 Jan 25.

40. Ammar A, Chtourou H, Hammouda O, et al. Acute and delayed responses of C-reactive protein, malondialdehyde and antioxidant markers after resistance training session in elite weightlifters: Effect of time of day. Chronobiol Int. 2015;32(9):1211-22. doi: 10.3109/07420528.2015.1079215. Epub 2015 Oct 9.

41. Messina M, Messina VL, Chan P. Soyfoods, hyperuricemia and gout: a review of the epidemiologic and clinical data. Asia Pac J Clin Nutr. 2011;20(3):347-58.

42. Villegas R, Xiang YB, Elasy T, et al. Purine-rich foods, protein intake, and the prevalence of hyperuricemia: The Shanghai Men's Health Study. Nutr Metab Cardiovasc Dis. 2012 May;22(5):409-16. doi: 10.1016/j.numecd.2010.07.012. Epub 2011 Jan 28.