Abstract
Background: Cardiovascular disease (CVD) and diabetes are leading causes of death and disability worldwide. In New Zealand (NZ) the burden of these diseases is greater in Māori than in NZ European, and greater still in rural Māori compared to urban Māori. Increases in rates of obesity, gout, diabetes and CVD have paralleled the rise in sugar consumption and suggest a potential causal pathway. High sugar intakes can increase blood uric acid levels. Hyperuricaemia is a major risk factor for gout, a condition strongly associated with Type 2 Diabetes Mellitus (T2DM) and CVD, with very high prevalence in East Coast Māori.
Objective: To examine the association between dietary sugars and various cardio-metabolic risk factors in a predominantly Māori population group in Tairawhiti/East Coast, using a specifically designed and validated food frequency questionnaire (FFQ). To further validate the FFQ for use in Māori populations.
Design: A preliminary cross-sectional analysis, in 87 NZ East Coast residents who attend Ngati Porou Hauroa health services, of the association between dietary sugars intake and serum uric acid (SUA), triglycerides (TGs), high-density lipoprotein (HDL) cholesterol, body mass index (BMI), glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Usual sugars (total available sugars, added sugars, sugars from non-alcoholic beverages (NABs), fruit sugars and fructose) consumption over the previous month was assessed via a specifically designed and validated 34-item FFQ. The relationship between sugars intakes and outcome variables was evaluated by linear regression analysis. Multivariate models included adjustment for BMI, sex, age, gout, glomerular filtration rate (eGFR), HbA1c, SUA, diuretics or BP-lowering medications, blood glucose-lowering medications, regular allopurinol use, and fruit and alcohol servings.
Results: The population had a mean age of 62 years and high prevalence of obesity, comorbidities and medication use. Non-obese individuals in the highest tertile of added sugars intake had significantly greater SUA (0.185 mmol/L; 95% CI: 0.084, 0.287) than those in the lowest tertile. The highest versus the lowest intakes of added sugars were associated with greater serum TG concentrations (0.72 mmol/L; 95% CI: 0.11, 1.32) and lower HDL cholesterol concentrations (0.16 mmol/L; 95% CI: -0.30, -0.02). BMI in the highest tertile of fruit sugars intake was 4.7 units (95% CI: 0.5, 8.8) higher than the lowest tertile. The highest fructose intakes were associated with HbA1c 9.4% (95% CI: -17.6, -0.2) lower than the lowest intakes. There was no association between dietary sugars and SBP but tertile two of total sugars intake had DBP 10.9 mmHg (95% CI: 4.3, 17.6) greater than tertile one.
Conclusion: In high-risk older Māori with a genetic tendency towards gout, higher added sugars intake may increase the risk of cardio-metabolic disturbances, particularly raised SUA and TGs and low HDL. Within this population, high fruit intakes may be contributing to excess energy intakes and therefore to greater BMI. Reduction of added sugars intakes in older, gout-affected Māori populations may be warranted.