Abstract
Abstract. Hyperuricemia is recognized as a lifestyle-related disease and the prevalence is increasing in many parts of the world. Excessive intake of purines increases serum uric acid concentration and is thought to be one factor causative of hyperuricemia. Therefore, it is thought that prevention of hyperuricemia by dietary control may be very important. This is an article of our basic research regarding the role of dietary fiber in the suppression of hyperuricemia induced by dietary purines in rats; in addition, clinical research suggesting the possibility that dietary fiber intake has a beneficial effect on the prevention or suppression of hyperuricemia in humans is discussed. Our own studies reveal that the test dietary fiber significantly suppresses the elevation of serum uric acid concentration induced by dietary RNA (12.3–46.2%), adenosine-5′-monophosphate (9.5–23.2%), adenosine (10.7–20.4%), or adenine (16.3–38.9%) and suppresses experimental hyperuricemia in rats. The mechanism is presumed to be mediated by suppression of the digestion and/or absorption of dietary purines by dietary fiber. In clinical studies, intake of dietary fiber decreases serum uric acid concentrations. Reports of recent epidemiological studies indicate that higher levels of hyperuricemia increase the prevalence of its comorbidities (e.g., chronic kidney disease, obesity, hypertension, diabetes, and cardiovascular disease) and dietary fiber intake is associated with significantly lower risk for hyperuricemia and its comorbidities. We wish to emphasize the importance of recognizing the validity of increased dietary fiber intake as a preventive or suppressive method for hyperuricemia and its comorbidities.
References
1 (2002) Optimal diets for prevention of coronary heart disease. JAMA. 288, 2569–2578.
2 (2006) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 114, 82–96.
3 (2007) Inflammation, obesity and comorbidities: the role of diet. Public Health Nutr. 10, 1164–1172.
4 (2004) Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr. 80, 1012–1018.
5 (2010) A prescription for lifestyle change in patients with hyperuricemia and gout. Curr Opin Rheumatol. 22, 165–172.
6 (2014) Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of atherosclerotic cardiovascular diseases in Japan – 2012 version. J Atheroscler Thromb. 20, 517–523.
7 . (2012) Treatment guide for diabetes 2012–2013. Tokyo: Bunkodo, 110 (in Japanese)
8 . (2009) The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res. 32, 3–107.
9 . (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 289, 2560–2572.
10 . (2001) Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 344, 3–10.
11 (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 336, 1117–1124.
12 . (2002) Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 25, 202–212.
13 . (2000) Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin Nutr. 54, 353–355.
14 (2012) 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Research. 64, 1431–1446.
15 (2009) Health benefits of dietary fiber. Nutr Rev. 67, 188–205.
16 (2012) The health benefits of dietary fiber: beyond the usual suspects of type 2 diabetes mellitus, cardiovascular disease and colon cancer. Metabolism. 61, 1058–1066.
17 (2002) Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. Am J Clin Nutr. 75, 834–839.
18 (2001)
Treatment of diabetes with high-fiber diets . In G.A. SpillerEd., Handbook of dietary fiber in human nutrition (vol. 3, pp. 373). Boca Raton, FL: CRC Press LLC.19 (2012) In S.S. ChoN. AlmeidaEds., Epidemiological studies of dietary fiber and cardiovascular disease. Dietary fiber and health (pp. 121). Boca Raton, FL: CRC Press LLC.
20 (2010) Effects of dietary fiber and its components on metabolic health. Nutrients. 2, 1266–1289.
21 (2012)
Consumption of total fiber and types of fiber are associated with a lower prevalence of obesity and abdominal adiposity in U.S. adults. NHANES 1999–2006 . Dietary fiber and health. (Cho, S.S.Almeida, N.eds., pp. 71, CRC Press LLC, Boca Raton, FL.22 (2003) Whole grain consumption and weight gain: a review of the epidemiological evidence, potential mechanisms and opportunities for future research. Proc Nutr Soc. 62, 25–29.
23 (2005) Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med. 165, 150–156.
24 (2005) Dietary fiber intake and risk factors for cardiovascular disease in French adults. Am J Clin Nutr. 82, 1185–1194.
25 (2013) Impact of dietary fiber intake on glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. Nutr J. 12, 159.
26 (2012) Systematic review of the prevalence of gout and hyperuricaemia in Australia. Intern Med J. 42, 997–1007.
27 (2013) Epidemiology of gout and hyperuricaemia in Italy during the years 2005–2009: a nationwide population-based study. Ann Rheum Dis. 72, 694–700.
28 (2010) Japanese guideline for the management of hyperuricemia and gout: second edition. Nucleosides Nucleotides Nucleic Acids. 30, 1018–1029.
29 (2011) Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 63, 3136–3141.
30 (2014) Comparison of nutrient intake and diet quality between hyperuricemia subjects and controls in Korea. Clin Nutr Res. 3, 56–63.
31 (2008) Dietary and lifestyle changes associated with high prevalence of hyperuricemia and gout in the Shandong coastal cities of Eastern China. J Rheumatol. 35, 1859–1864.
32 (2013) Hyperuricaemia and gout in New Zealand rural and urban Māori and non-Māori communities. Intern Med J. 43, 678–684.
33 (2014) Prevalence of hyperuricemia among Chinese adults: a national cross-sectional survey using multistage, stratified sampling. J Nephrol. 27, 653–658.
34 (2002) Renal underexcretion of uric acid is present in patients with apparent high urinary uric acid output. Arthritis Rheum. 47, 610–613.
35 (2005) Pathogenesis of gout. Ann Intern Med. 143, 499–516.
36 (2006) Uric acid and inflammatory markers. Eur Heart J. 27, 1174–1181.
37 (1991) Incidence and risk factors for gout in white men. JAMA. 266, 3004–3007.
38 (1997) Close correlation between visceral fat accumulation and uric acid metabolism in healthy men. Metabolism. 46, 1162–1165.
39 (1996) The management of gout. N Engl J Med. 334, 445–451.
40 (2005) Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med. 165, 742–748.
41 (2003) Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension. 41, 1183–1190.
42 (2011) 2011 Recommendations for the diagnosis and management of gout and hyperuricemia. Postgrad Med. 123(Suppl 1), 3–36.
43 (2000) Uric acid and serum antioxidant capacity: a reaction to atherosclerosis? Atherosclerosis. 148, 131–139.
44 (2002) Uric acid and cardiovascular risk. Curr Opin Pharmacol. 2, 126–130.
45 (2011) Metabolic syndrome and dietary components are associated with coronary artery disease risk score in free-living adults: a cross-sectional study. Diabetol Metab Syndr. 3, 7.
46 (2006) Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther. 8(suppl 1), S2.
47 . (2012) Clinical practice guidebook for diagnosis and treatment of chronic kidney disease 2012. Tokyo: Igakusha Co. Ltd, 145 (in Japanese).
48 (2008) Uric acid and cardiovascular risk. N Engl J Med. 359, 1811–1821.
49 (2012) Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007–2008. Am J Med. 125, 679–687.
50 (2010) Gout. Lancet. 375, 318–328.
51 (2005) 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. 52, 283–289.
52 (2008) Dietary factors associated with hyperuricemia in adults. Semin Arthritis Rheum. 37, 243–250.
53 (2012) Purine-rich foods, protein intake, and the prevalence of hyperuricemia: the Shanghai Men’s Health Study. Nutr Metab Cardiovasc Dis. 22, 409–416.
54 (2011) Dietary intake and the risk of hyperuricemia, gout and chronic kidney disease in elderly Taiwanese men. Aging Male. 14, 195–202.
55 (2009) Metabolic pathway and regulation of uric acid production. Hyperuricemia and Gout. 17, 106–111. (in Japanese).
56 (2015) Roles of diets and dietary factors in the pathogenesis, management and prevention of abnormal serum uric acid levels. PharmaNutrition. 3, 29–45.
57 (2013)
Approach to diet and alcohol in treatment of the patient with gout and hyperuricemia . Gout; Diagnosis and management of gouty arthritis and hyperuricemia. (Terkeltaub, R.Edwards, N.L.eds. vol. 3, pp. 143, Professional Communications Inc, NY.58 (2005) Dietary factors and hyperuricemia. Curr Pharm Des. 11, 4133–4138.
59 (1994) Hyperuricemia and insulin resistance. J Clin Endocrinol Metab. 78, 25–29.
60 (2002) Gout, diet, and the insulin resistance syndrome. J Rheumatol. 29, 1350–1355.
61 (2006) Diagnosis and management of gout. BMJ. 332, 1315–1319.
62 (1997) Effect of dietary fiber on the amount of purine metabolites in the serum and urine of rats. J Agric Sci Tokyo Nogyo Daigaku (Tokyo University of Agriculture). 42, 163–172.
63 (2002) Dietary fiber suppresses elevations of uric acid and allantoin in serum and urine induced by dietary RNA and increases its excretion to feces in rats. J Nutr Sci Vitaminol. 48, 184–193.
64 (2003) Suppressive effect of viscous dietary fiber on elevations of uric acid in serum and urine induced by dietary RNA in rats is associated with strength of viscosity. Int J Vitam Nutr Res. 73, 369–376.
65 (2004) Dietary fiber suppresses elevation of uric acid and urea nitrogen concentrations in serum of rats with renal dysfunction induced by dietary adenine. Int J Vitam Nutr Res. 74, 253–263.
66 (2004) Suppressive effect of dietary fiber on elevation of serum uric acid concentration induced by dietary adenosine and adenosine-5′-monophosphate in rats. J Jpn Assoc Dietary Fiber Res. 8, 83–91.
67 (2008) Blood glucose and serum uric acid concentrations in streptozotocin-induced diabetic rats fed dietary RNA vary with type of dietary fiber. J Jpn Assoc Dietary Fiber Res. 12, 67–80.
68 (2009) Supplementation of the diet with the functional fiber PolyGlycoplex is well tolerated by healthy subjects in a clinical trial. Nutr J. 8, 9.
69 (2007) The effect on the serum uric acid level of long-term intake of chitosan-supplemented food and its safety in adults. J Jpn Soc Clin Nutr. 29, 104–113 (in Japanese).
70 (2012) Serum uric acid in US adolescents: distribution and relationship to demographic characteristics and cardiovascular risk factors. Pediatric Research. 72, 95–100.
71 (2015) Cross-sectional analysis of nutrition and serum uric acid in two Caucasian cohorts: the AusDiab Study and the Tromsø study. Nutr J. 14, 49.
72 (2010) Lack of association between dietary fructose and hyperuricemia risk in adults. Nutr Metab (Lond). 7, 16.
73 (1946) A spectrophotometric method for the measurement of ribonuclease activity. J Biol Chem. 164, 563–568.
74 (1977) Transport of purine nucleotides and nucleosides by in vitro rabbit ileum. Am J Physiol. 233, E47–E55.
75 (1984) Absorption and metabolism of adenine, adenosine-5′-monophosphate, adenosine and hypoxanthine by the isolated vasculary perfused rat small intestine. J Nutr. 114, 753–760.
76 (2004) Dietary fiber modulates hyperuricemia induced by dietary purine compounds in rats. Current Topics in Biotechnology. 1, 1–14.
77 (2006) Viscosity as related to dietary fiber: a review. Crit Rev Food Sci Nutr. 46, 649–663.
78 (1999) Fiber, inulin and oligofructose: similarities and differences. J Nutr. 129, 1424S–1427S.
79 (2011)
Overview of dietary fiber and its influence on gastrointestinal health . Nondigestible carbohydrates and digestive health. (Paeschke T.M.Aimutis, W.R.eds., pp. 185, Blackwell Publishing, Ltd. Ames, Iowa.80 (2006) Chitosan shifts the fermentation site toward the distal colon and increases the fecal short-chain fatty acids concentrations in rats. Int J Vitam Nutr Res. 76, 57–64.
81 (2002) Applications of inulin and oligofructose in health and nutrition. J Biosci. 27, 703–714.
82 (1999) Concepts in functional foods: The case of inulin and oligofructose. J Nutr. 129, 1398S–1401S.
83 (1980) High-fiber diet in the control of diabetes in rats. Endocrinol Japon. 27, 169–173.
84 (2005) Involvement of endogenous glucagon-like peptide-1 (7–36) amide on glycaemia-lowering effect of oligofructose in streptozotocin-treated rats. J Endocrinology. 185, 457–465.
85 (2002) Barley bread containing lactic acid improves glucose tolerance at a subsequent meal in healthy men and women. J Nutr. 132, 1173–1175.
86 . (2006) Serum uric acid as a harbinger of metabolic outcome in subjects with impaired glucose tolerance: the Finnish Diabetes Prevention Study. Diabetes Care. 29, 709–711.
87 (2008) The paradoxical relationship between serum uric acid and cardiovascular disease. Clin Chim Acta. 392, 1–7.
88 (2005) Uric acid and oxidative stress. Curr Pharm Des. 11, 4145–4151.
89 (2005) Risk factors for development of decreased kidney function in a southeast Asian population: a 12-year cohort study. J Am Soc Nephrol. 16, 791–799.
90 (2004) Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort. Am J Kidney Dis. 44, 642–650.
91 (2008) Uric acid and incident kidney disease in the community. J Am Soc Nephrol. 19, 1204–1211.
92 (1986) Animal model of adenine-induced chronic renal failure in rats. Nephron. 44, 230–234.
93 (2010) Effects of gum arabic in rats with adenine-induced chronic renal failure. Exp Biol Med (Maywood). 235, 373–382.
94 (1983) Metabolic effects of dietary purine and pyrimidine bases in rats. Agric Biol Chem. 47, 1297–1304.
95 (1982) Adenine-induced hyperuricemia and renal damage in rats. J Jpn Soc Biosci Biotech Agrochem. 56, 655–663. (in Japanese)
96 (1988) Differences in uricogenic effects of dietary purine bases, nucleosides and nucleotides in rats. J Nutr. 118, 780–786.
97 (2008) The effects of gum arabic oral treatment on the metabolic profile of chronic renal failure patients under regular haemodialysis in Central Sudan. Nat Prod Res. 22, 12–21.
98 (1997) Effect of chitosan on renal function in patients with chronic renal failure. J Pharm Pharmacol. 49, 721–723.
99 (1996) Supplementation with gum arabic fiber increases fecal nitrogen excretion and lowers serum urea nitrogen concentration in chronic renal failure patients consuming a low-protein diet. Am J Clin Nutr. 63, 392–398.
100 (1994) Effect of chitin and chitosan on nutrient digestibility and plasma lipid concentrations in broiler chickens. Br J Nutr. 72, 277–288.
101 (2004) Dietary fiber in conservative management of chronic renal failure. Pediatr Nephrol. 19, 1069–1070.
102 (2006) Acacia gum in chronic renal failure. Therapy. 3, 183–185.
103 (2004) Association of obesity with inflammation in chronic kidney disease: a cross-sectional study. J Ren Nutr. 14, 201–207.
104 (2011) Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study. Kidney Int. 80, 1231–1238.
105 (2012) High dietary fiber intake associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int. 81, 300–306.
106 (2002) Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 75, 492–498.
107 (2006) Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care. 29, 207–211.
108 (2005) Dietary glycemic index, glycemic load, cereal fiber, and plasma adiponectin concentration in diabetic men. Diabetes Care. 28, 1022–1028.
109 (2009) Uremic toxins originating from colonic microbial metabolism. Kidney Int Suppl. 114, S12–S19.
110 (2011) Dietary fiber as a carrier of dietary antioxidants: an essential physiological function. J Agric Food Chem. 59, 43–49.
111 (2009) Bioavailability of phenolic antioxidants associated with dietary fiber: plasma antioxidant capacity after acute and long-term intake in humans. Plant Food Hum Nutr. 64, 102–107.
112 (2011) The role of dietary fiber in the bioaccessibility and bioavailability of fruit and vegetable antioxidants. J Food Sci. 76, R6–R15.
113 (2014) Obesity, metabolic syndrome, and dietary therapeutical approaches with a special focus on nutraceuticals (polyphenols): a mini-review. Int J Vitam Nutr Res. 84, 113–123.
114 (2013) Foods with added fiber lower serum creatinine levels in patients with chronic kidney disease. J Ren Nutr. 23, e29.
115 (2015) Dietary fiber effects in chronic kidney disease: a systematic review and meta-analysis of controlled feeding trials. Eur J Clin Nutr. 69, 761–768.
116 (2011) Carbohydrate nutrition is associated with the 5-year incidence of chronic kidney disease. J Nutr. 141, 433–439.
117 (2011) Fluid and nutrient intake and risk of chronic kidney disease. Nephrology. 16, 326–334.
118 (2013) Cross-sectional associations between macronutrient intake and chronic kidney disease in a population at high cardiovascular risk. Clin Nutr. 32, 606–612.
119 (2014) Effects of chicory inulin on serum metabolites of uric acid, lipids, glucose, and abdominal fat deposition in quails induced by purine-rich diets. J Med Food. 17, 1214–1221.
120 (2010) Acute effect of milk on serum urate concentrations: a randomized controlled crossover trial. Ann Rheum Dis. 69, 1677–1682.
121 (2015) Nonpharmacological management of gout and hyperuricemia: hints for better lifestyle. Am J Lifestyle Med. 11, 321–329.
122 (2007)
Exopolysaccharides from lactic acid bacteria: food uses, production, chemical structures, and health effects . In Handbook of nutraceuticals and functional foods. (Wildman, R.C.ed.), vol. 2, pp. 353, CRC Press LLC, Boca Raton, FL.123 (1976) Effect of oral purines on serum and urinary uric acid of normal, hyperuricemic and gouty humans. J Nutr. 106, 428–434.
124 (2003) A case-control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr. 78, 690–701.
125 (2008) Dietary fiber intake in relation to coronary heart disease and all-cause mortality over 40 y: the Zutphen Study. Am J Clin Nutr. 88, 1119–1125.
126 (2009) A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 169, 659–669.
127 (2004) Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med. 164, 370–376.
128 (1970) Dietary protein level and uric acid metabolism in normal man. J Nutr. 100, 249–261.
129 (2013) Dietary fibre consumption and insulin resistance – the role of body fat and physical activity. Br J Nutr. 110, 375–383.
130 (2008) Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population. Am J Epidemiol. 167, 1226–1234.
131 (2009) Omega-3 and renal function in older adults. Curr Pharm Des. 15, 4149–4156.
132 (1996) Clustering of dyslipidemia, hyperuricemia, diabetes, and hypertension and its association with fasting insulin and central and overall obesity in a general population. Atherosclerosis Risk in Communities Study Investigators. Metabolism. 45, 699–706.
133 (2003) Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA. 290, 199–206.
134 (2009) Gout. Hyperuricemia and cardiovascular disease: how strong is the evidence for a causal link? Arthritis Res Ther. 11, 240.
135 . (2002) Cause-specific mortality in a population with diabetes: South Tees Diabetes Mortality Study. Diabetes Care. 25, 43–48.
136 (2010) Cardiovascular complications in type 1 diabetes mellitus. Diabetes Metab. 36, 341–344.
137 (2012) High plasma uric acid concentration: causes and consequences. Diabetol Metab Syndr. 4, 12.
138 (2004) Effect of high intakes of fruit and vegetables on redox status in type 2 onset diabetes: a pilot study. Int J Vitam Nutr Res. 74, 313–320.
139 (2000) Long term effect of fibre supplement and reduced energy intake on body weight and blood lipids in overweight subjects. Acta Medica (Hradec Králové). 43, 129–132.
140 . (2002) Therapeutic effects of psyllium in type 2 diabetic patients. Eur J Clin Nutr. 56, 830–842.
141 (2002) Effect of prickly pear (Opuntia robusta) on glucose- and lipid-metabolism in non-diabetics with hyperlipidemia – a pilot study. Wien Klin Wochenschr. 114, 840–846.
142 (2006) Effect of oatmeal supplementation on the serum cholesterol levels in adults with boundary and mild hypercholesterolemia. Jpn J Nutr Diet. 64, 77–86 (in Japanese).
143 (2004) Consumption of high-pressurized vegetable soup increases plasma vitamin C and decreases oxidative stress and inflammatory biomarkers in healthy humans. J Nutr. 134, 3021–3025.
144 (2014) Mediterranean diet intervention for patients with hyperuricemia: a pilot study. Rheumatol Int. 34, 759–762.
145 (2009) Definition of the Mediterranean diet based on bioactive compounds. Crit Rev Food Sci Nutr. 49, 145–152.
146 (2011) Long-term adherence to the Mediterranean diet reduces the prevalence of hyperuricemia in elderly individuals, without known cardiovascular disease: the Ikaria study. Maturitas. 70, 58–64.
147 (2012) Adherence to the Mediterranean diet and serum uric acid: the ATTICA study. Scand J Rheumatol. 41, 442–449.
148 (2013) Mediterranean diet and risk of hyperuricemia in elderly participants at high cardiovascular risk. J Gerontol A Biol Sci Med Sci. 68, 1263–1270.
149 (2012) The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study. PLoS One. 7, e38123.
150 (1990) Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch Nutrition Surveillance System). J Clin Epidemiol. 43, 1297–1303.
151 (2008) Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men. Am J Clin Nutr. 87, 1480–1487.
152 (2007) Influence of habitual diet on antioxidant status: a study in a population of vegetarians and omnivores. Eur J Clin Nutr. 61, 1011–1022.
153 (2000) Effect of low level lead exposure on hyperuricemia and gout among middle aged and elderly men: the normative aging study. J Rheumatol. 27, 1708–1712.
154 (2004) Beer, liquor, and wine consumption and serum uric acid level; the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 51, 1023–1029.
155 (2008) Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 59, 109–116.
156 (2009) Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents. J Pediatr. 154, 807–813.
157 (2010) The relation of coffee consumption to serum uric acid in Japanese men and women aged 49–76 years. J Nutr Metab. pii. 930757. doi: 10.1155/2010/930757
158 (2007) Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey. Arthritis Rheum. 57, 816–821.
159 (2008) Vitamin C intake and serum uric acid concentration in men. J Rheumatol. 35, 1853–1858.
160 (1976) Ascorbic acid-induced uricosuria. A consequency of megavitamin therapy. Ann Intern Med. 84, 385–388.
161 (1977) The effect of ascorbic acid on uric acid excretion with a commentary on the renal handling of ascorbic acid. Am J Med. 62, 71–76.
162 (2011) Effect of oral vitamin C supplementation on serum uric acid: a meta-analysis of randomized controlled trials. Arthritis Rheum. 63, 1295–1306.
163 (2004) Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: The urate redox shuttle. Nutr. Metab (Lond). 1, 10.
164 (2004) Adminstration of procyanidins from grape seeds reduces serum uric acid levels and decreases hepatic xanthine dehydrogenase/oxidase activities in oxonate-treated mice. Basic Clin Pharmacol Toxicol. 94, 232–237.
165 (2007) Hypouricemic action of selected flavonoids in mice: structure-activity relationships. Biol Pharm Bull. 30, 1551–1556.
166 (1995) Structure-activity relationship of caffeic acid analogues on xanthine inhibition. Anticancer Res. 15, 703–705.
167 (2004) Dietary fiber and C-reactive protein: findings from national health and nutrition examination survey data. J Nutr. 134, 1181–1185.
168 (2006) Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr. 83, 760–766.
169 . (2006) Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 145, 1–11.
170 (2015) Cross-comparison of diet quality indices for predicting chronic disease risk: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study. Br J Nutr. 113, 259–269.
171 (2013) Mediterranean diet, kidney function, and mortality in men with CKD. Clin J Am Soc Nephrol. 8, 1548–1555.
172 (2009) Adherence to the Mediterranean diet is associated with lower prevalence of obesity among elderly people living in Mediterranean islands: the MEDIS study. Int J Food Sci Nutr. 60(Suppl 6), 137–150.
173 (1974) Epidemiologic studies on coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: demographic, physical, dietary and biochemical characteristics. J Chronic Dis. 27, 345–364.
174 (1990) Dietary fiber. Gendai iryo. 23, 33–37. (in Japanese).
175 . (2015) The National Health and Nutrition Survey Japan, 2011. Tokyo: Daiichi-shuppan, 276 (in Japanese).
176 . (2005) Nutrition and your health: Dietary guidelines for Americans. 2005 Dietary Guidelines Advisory Committee Report. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC
177 . (2005) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (Macronutrients). In Dietary, functional, and total fiber (Institute of Medicine of the National Academiesed., pp. 339, The National Academies Press, Washington, DC.
178 (2012) Dietary fiber and saturated fat intake associations with cardiovascular disease differ by sex in the Malmö Diet and Cancer Cohort: a prospective study. PLoS One. 7, e31637.