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Mediterranean diets and health risks for the elderly at high cardiovascular risk

What is the relationship between a Mediterranean diet and the risk of hyperuricemia in the elderly? Dr. Salas-Salvado joins us to discuss his most recent research in the The Journals of Gerontology Series A: Biological Sciences and Medical Sciences.

What is hyperuricemia, how common is it, and what can be its consequences?

Hyperuricemia is defined as elevated concentrations of serum uric acid in plasma (higher than 7 mg/dL in men and higher than 6 mg/dL in women). It occurs when there is an overproduction or underexcretion of uric acid or often the combination of both.

The prevalence of both gout and hyperuricemia has increased over the past two decades, which is related to increasing frequencies of adiposity and hypertension. It has been estimated that the prevalence of gout among US adults was 3.9%, 5.9% for men and 2% for women, this mean that 8.3 million individuals suffer from gout in the United States. It has also been estimated that 21.4% of adults had elevated serum uric acid levels, namely 43.3 million of individuals in the United States. It has also been shown that its prevalence increases with age.

Hyperuricemia has also been regarded as the precursor of gout; an inflammatory arthritis triggered by the crystallization of uric acid within the joints, decreasing life quality. Moreover, it has been strongly associated with metabolic syndrome, hypertension, type-2 diabetes mellitus, and chronic kidney disease and also with cardiovascular morbidity and mortality.

Why is your study significant? What are its significant findings?

We have evaluated the associations between adherence to the Mediterranean Diet (MeDiet) and the prevalence, incidence and reversion of hyperuricemia in elderly subjects at high cardiovascular risk participating in a primary prevention randomized trial. Also, we have assessed which of the specific typical components of the MeDiet were associated with hyperuricemia. We have shown that after a median follow-up of five years, 24.9% of subjects who did not have hyperuricemia at baseline developed hyperuricemia, whereas 43.2% of hyperuricemic individuals at baseline reverted this condition. In the cross-sectional analyses, we have observed that an increase in the adherence to the MeDiet was associated to a decreased prevalence of hyperuricemia. The baseline consumption of red meat, fish and seafood, and wine were associated with a higher prevalence of hyperuricemia. We have also found that those individuals who have a higher adherence to the MeDiet had more probabilities to reverse this condition than those individuals with a lower adherence. Furthermore, these associations were independent of other risk factors for hyperuricemia, such as age, body-mass-index, smoking, physical activity, hypertension, and diabetes.

Even though previous studies have assessed the relationship between some dietary factors and hyperuricemia, the association between dietary patterns and hyperuricemia remains unknown. Our study is unique in prospectively evaluating the adherence to the MeDiet and hyperuricemia. Our findings provide evidence of the benefits of healthy dietary patterns on the reversion of hyperuricemia. What is more, reversion was achieved by the MeDiet alone, without weight loss or physical activity counselling.

What constitutes a MeDiet?

The traditional Mediterranean diet is characterized by a high consumption of fruits, vegetables, legumes, olive oil, nuts, and whole grain; a moderate consumption of wine, dairy products, and poultry; and a low consumption of red meat, sweet beverages, creams, and pastries. The sofrito sauce is also another component of the Mediterranean diet; it is made with tomato, onion, spices, garlic and simmered with olive oil. Its high content in antioxidants makes it anti-inflammatory.

Is a MeDiet beneficial in other ways, such as in decreasing or reversing the risk of gout?

It has been consistently demonstrated that Mediterranean Diet has many healthy benefits mainly due to its antioxidant and anti-inflammatory properties. It has been inversely related with dyslipidemia, diabetes, metabolic syndrome, hypertension, and other chronic diseases. Recently, the findings of the PREDIMED Study — a large, multicenter randomized clinical trial — showed that among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. So, Mediterranean diet has also been strongly and inversely related with cardiovascular morbidity and mortality.

Jordi Salas-Salvadó is in the author of “Mediterranean Diet and Risk of Hyperuricemia in Elderly Participants at High Cardiovascular Risk” (available to read for free for a limited time) in the latest issue of The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. He has occupied teaching and research posts at the Faculty of Medicine in Reus (UB) since 1984. At present, he is professor of Nutrition (Department of Biochemistry and Biotechnology) and director of the Human Nutrition Unit of the Faculty of Medicine and Health Sciences of the Rovira i Virgili University (URV). He has directed 12 research projects financed by public bodies and 21 projects in conjunction with the pharmaceutical or food industries. He is one of the leaders of the PREDIMED clinical trial and has published more than 220 original articles in national and international journals, as well as numerous reviews and editorials. Editor of 7 books, he has also co-authored more than 50 books.

The Journals of Gerontology were the first journals on aging published in the United States. The tradition of excellence in these peer-reviewed scientific journals, established in 1946, continues today. The Journals of Gerontology, Series A publishes within its covers the Journal of Gerontology: Biological Sciences and the Journal of Gerontology: Medical Sciences.

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Image credit: Rustic Italian Dinner with red wine olives and salad. Photo by edoneil, iStockphoto.

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