Why does hyperuricemia favor boys over girls?

According to the China Chronic Disease and Risk Factor Monitoring Report, the prevalence of hyperuricemia among residents aged 18 and above in my country was 14.0% in 2018, and the prevalence rate among men (24.5%) was 6.8 times that of women (3.6%)! How can hyperuricemia be "preferred to boys over girls"?

In addition to gout, hyperuricemia is also associated with multi-system diseases

Uric acid is the end product of purine metabolism. The saturation of uric acid is about 420 μmol/L at a body temperature of 37°C. When this value is exceeded, urate will form crystals and deposit in various tissues, such as the kidneys and joint cavities, causing tissue damage. Excessive urate production or reduced renal uric acid excretion, or both, can cause hyperuricemia. According to the standards of the "Chinese Multidisciplinary Expert Consensus on the Diagnosis and Treatment of Hyperuricemia-Related Diseases", a blood uric acid level >420 μmol/L (7 mg/dl) is diagnosed as hyperuricemia.

Most patients with hyperuricemia have no clinical symptoms, but some patients may develop gout, manifested as gouty arthritis, gouty kidney, tophi, etc. In addition, hyperuricemia is also related to the occurrence and development of systemic diseases such as kidney, endocrine metabolism, cardiovascular and cerebrovascular diseases.

There is a huge difference between men and women in hyperuricemia

Differences between men and women in hormones, diet, and drinking lead to a much higher prevalence of hyperuricemia in men than in women.

Hormones: Androgens can promote uric acid reabsorption and inhibit uric acid excretion, while estrogens can promote uric acid excretion. This physiological difference causes a decrease in uric acid excretion in men, thereby increasing the risk of hyperuricemia.

Diet: The production of uric acid caused by food is proportional to the purine content in the food. Since men are more likely to eat high-purine foods, such as meat, seafood and animal offal, hyperuricemia occurs.

Drinking: Alcohol can stimulate the synthesis of lactic acid in the human body. Lactic acid competes with uric acid when it is excreted from the kidneys, thereby inhibiting the kidneys from excreting uric acid. In addition, some alcoholic beverages (especially beer) contain purines, so drinking (especially excessive drinking) is a key factor in causing elevated blood uric acid. Men generally drink more alcohol than women, so they are at a higher risk of hyperuricemia.

Can uric acid be lowered if it is already high?

Eat a balanced diet

Control total daily calorie intake (specific energy intake is based on achieving and maintaining normal weight, and is adjusted according to the patient's height, weight, and physical activity level, see Table 1 for details).

Note: Body mass index (BMI) can be used to determine weight status, BMI = weight (kg) / height2 (m2). BMI < 18.5 kg/m2 is underweight, 18.5 kg/m2 ≤ BMI < 24.0 kg/m2 is normal weight, 24 kg/m2 ≤ BMI < 28 kg/m2 is overweight, and BMI ≥ 28 kg/m2 is obese.

Stick to a low-purine diet (Table 2), eat at least 500 grams of fresh vegetables per day, drink 300 ml of skim or low-fat milk and its products, eat 1 egg, and limit the intake of high-purine foods such as animal offal, seafood and meat.

Drink plenty of water

Drinking more than 2000 ml of water every day can increase the excretion of uric acid.

Limit alcohol consumption

Patients with hyperuricemia should limit their alcohol intake and avoid drinking rice wine, beer and liquor.

Weight control

Losing weight can effectively lower blood uric acid levels. It is recommended that patients with hyperuricemia keep their weight within the normal range (BMI 18.5-23.9 kg/m2).

Regular exercise

Regular exercise can reduce the frequency of gout attacks. It is recommended that patients with hyperuricemia perform at least 150 minutes (30 minutes/day × 5 days/week) of moderate-intensity aerobic exercise per week, that is, the heart rate during exercise should be within the range of (220-age)*(50%-70%). Avoid strenuous exercise and sudden cold during exercise to prevent gout attacks.

All of the above non-drug intervention measures can help lower blood uric acid levels, but if the blood uric acid level remains high after the above methods, or if gout symptoms do not improve significantly, standardized drug treatment should be carried out under the guidance of a doctor.