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Hyperuricaemia in the Pacific: why the elevated serum urate levels?

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Abstract

Pacific Island populations, particularly those of Polynesian descent, have a high prevalence of hyperuricaemia and gout. This is due to an inherently higher urate level among these populations with a demonstrated genetic predisposition. While an excess of urate can cause pathology, urate is also important for human health. It has been implicated as an antioxidant, has a neuroprotective role and is involved in innate immune responses. This paper provides a brief review of urate levels worldwide, with a particular focus on island Southeast Asia and the Pacific. We then present possible evolutionary explanations for the elevated serum urate levels among Pacific populations in the context of the physiological importance of urate and of the settlement history of the region. Finally, we propose that ancestry may play a significant role in hyperuricaemia in these populations and that exposure to malaria prior to population expansion into the wider Pacific may have driven genetic selection for variants contributing to high serum urate.

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Author information

Authors and Affiliations

  1. Department of Anatomy, Allan Wilson Centre for Molecular Ecology and Evolution, University of Otago, PO Box 913, Dunedin, New Zealand

    Anna L. Gosling & Elizabeth Matisoo-Smith

  2. Department of Biochemistry, University of Otago, PO Box 56, Dunedin, New Zealand

    Anna L. Gosling & Tony R. Merriman

Authors
  1. Anna L. Gosling
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  2. Elizabeth Matisoo-Smith
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  3. Tony R. Merriman
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Corresponding author

Correspondence to Anna L. Gosling.

Additional information

Elizabeth Matisoo-Smith and Tony R. Merriman have contributed equally to this study.

Appendix: Mean SU levels and prevalence of gout and hyperuricaemia in different adult male populations worldwide summarised from the published literature

Appendix: Mean SU levels and prevalence of gout and hyperuricaemia in different adult male populations worldwide summarised from the published literature

Location

Population

n

Age range

Mean SU

Prevalence

References

mg/dL

mmol/L

HU (%)

Gout (%)

Oceania

New Zealand

Māori

388

>15 years

7.1 ± 1.5

0.42 ± 0.09

49

–

[94]

New Zealand

Māori

215

20–64 years

–

–

27.8

18.4

[95]

New Zealand

NZ “non-Māori”

125

20–64 years

–

–

15.3

4.0

[95]

Cook Islands

Rarotongans

243

>20 years

7.0 ± 1.4

0.41 ± 0.08

44

2.5

[96]

Cook Islands

Pukapukans

188

>20 years

7.0 ± 1.1

0.42 ± 0.07

48.5

5.4

[96]

Papeete, Tahiti

Tahitians

179

20–50 years

7.5

0.45

–

–

[97]

Hawaii

Hawaiians

49

22–72 years

5.4 ± 1.1

0.32 ± 0.07

–

–

[13]

Kaneohe, Hawaii

Hawaiians

11

“Adult”

6.4 ± 1.4

0.38 ± 0.08

–

–

[98]

Apia, Samoa

Samoans (urban)

325

>20 years

6.7 ± 1.4

0.40 ± 0.08

36.4

7.2

[20]

Samoa

Samoans (rural)

358

>20 years

6.9 ± 1.2

0.41 ± 0.07

43.3

6.2

[20]

American Samoa

American Samoans

71

–

6.8 ± 1.2

0.40 ± 0.07

–

–

[99]

Nuku’alofa, Tonga

Tongans (urban)

177

20–69 years

6.5 ± 0.1

0.39 ± 0.00

–

2.7

[21]

Foa Island, Tonga

Tongans (rural)

199

20–69 years

5.3 ± 0.0

0.32 ± 0.00

–

0

[21]

Suva, Fiji

Fijians (urban)

401

>20 years

6.6 ± 1.2

0.39 ± 0.07

32.4

0.002

[22]

Fiji

Fijians (rural)

242

>20 years

6.0 ± 1.0

0.36 ± 0.06

16.9

0

[22]

Tokelau

Tokelauans

433

35–74 years

6.6 ± 1.3

0.39 ± 0.08

–

–

[100]

Tuvalu

Tuvaluans

189

>20 years

6.6

0.39

32.3

0

[101]

Nauru

Nauruans

217

>20 years

7.6 ± 1.6

0.45 ± 0.10

64

6.9

[102]

Marshall Islands

Marshall Islanders

188

>15 years

6.6 ± 1.3

0.39 ± 0.08

–

1.7

[103]

Rongelap, Marshall Islands

Marshall Islanders

37

>15 years

6.1 ± 1.0

0.36 ± 0.06

–

–

[103]

Utirik, Marshall Islands

Marshall Islanders

68

>15 years

6.5 ± 1.4

0.39 ± 0.08

–

–

[103]

Ebeye, Marshall Islands

Marshall Islanders

45

>15 years

6.9 ± 1.4

0.41 ± 0.08

–

–

[103]

Majuro, Marshall Islands

Marshall Islanders

29

>15 years

6.9 ± 1.2

0.41 ± 0.07

–

–

[103]

Caroline Islands

Carolinians

26

>40 years

7.3 ± 1.7

0.43 ± 0.10

–

–

[104]

Mariana Islands

Chamorro

160

>40 years

6.2 ± 1.5

0.37 ± 0.09

–

–

[104]

Guam, Mariana Islands

Chamorro (urban)

273

>20 years

7.1 ± 1.5

0.42 ± 0.09

48

1.5

[18]

Rota, Mariana Islands

Chamorro (rural)

122

>20 years

7.2 ± 1.4

0.43 ± 0.08

52

4.1

[18]

Palau

Palauans

510

>20 years

6.7 ± 1.6

0.40 ± 0.10

37

1.3

[18]

Kwaio, Solomon Islands

Solomon Islanders

127

18–54 years

6.5 ± 1.6

0.39 ± 0.10

–

–

[105]

Aita, Solomon Islands

Solomon Islanders

81

18–54 years

6.1 ± 1.1

0.36 ± 0.07

–

–

[105]

Baegu, Solomon Islands

Solomon Islanders

126

18–54 years

6.2 ± 1.6

0.37 ± 0.09

–

–

[105]

Lau, Solomon Islands

Solomon Islanders

77

18–54 years

5.5 ± 0.9

0.33 ± 0.06

–

–

[105]

Nagovisi, Solomon Islands

Solomon Islanders

109

18–54 years

5.3 ± 0.9

0.31 ± 0.05

–

–

[105]

Nasioi, Solomon Islands

Solomon Islanders

59

18–54 years

6.0 ± 0.9

0.36 ± 0.05

–

–

[105]

Kitava, Trobiand Island, PNG

Trobriand Islanders

41

40–59 years

5.1

0.30

–

–

[106]

East Sepik, PNG

Salatas

71

 

4.9 ± 1.4

0.29 ± 0.09

–

–

[17]

Eastern Highlands Province, PNG

Lufa (Highlanders)

329

>15 years

5.6

0.32

–

–

[86]

Simbu Province, PNG

Nomane (Highlanders)

39

>15 years

6.1

0.36

–

–

[86]

Oro Province, PNG

Managalas (Highlanders)

20

>15 years

5.5

0.33

–

–

[86]

Madang Coast. PNG

Madang Coast (Lowlanders)

43

>15 years

4.8

0.29

–

–

[86]

Karkar Island, PNG

Karkar Islanders

260

>15 years

5.7

0.34

–

–

[86]

Western Province, PNG

Kiunga (Lowlanders)

32

>15 years

5.3

0.32

–

–

[86]

Tukisenta, Western Highlands, PNG

Murapin Highlanders

391

>15 years

5.4

0.32

–

–

[107]

Koki, Port Moresby, PNG

“Melanesians” (urban)

86

>18 years

6.2 ± 1.3

0.37 ± 0.08

20

–

[19]

Kalo Village, Central Province, PNG

“Melanesians” (rural)

22

>18 years

4.2 ± 1.3

0.25 ± 0.08

–

–

[19]

Australia

Australian Caucasians

200

30–39 years

6.6 ± 0.2

0.39 ± 0.01

12

–

[108]

Australia

Representative Australian population

1,673

70–97 years

6.0 ± 1.3

0.36 ± 0.08

23

–

[109]

Mitchell River, Australia

Aborigines

27

20–98 years

5.5 ± 1.0

0.33 ± 0.06

–

–

[110]

Aurukun, Australia

Aborigines

82

20–70 years

6.0 ± 1.2

0.36 ± 0.07

–

–

[110]

Weipa, Australia

Aborigines

3

>20 years

5.3 ± 1.7

0.31 ± 0.10

–

–

[110]

Island Southeast Asia

Java, Indonesia

Malayo-Polynesians

2,184

>15 years

6.2 ± 1.3

0.37 ± 0.08

24.3

1.7

[111]

Manila, Philippines

Filipinos (urban)

140

21–87 years

5.3 ± 1.4

0.32 ± 0.08

–

–

[16]

Cebu, Philippines

Filipinos (rural)

146

21–87 years

5.1 ± 1.2

0.30 ± 0.07

–

–

[16]

La Union, Philippines

Filipinos (rural)

197

21–87 years

5.3 ± 1.3

0.32 ± 0.08

–

–

[16]

Seattle, USA

Filipinos

113

21–87 years

6.3 ± 1.4

0.37 ± 0.08

–

–

[16]

Hawaii

Filipinos (urban)

60

21–87 years

6.1 ± 1.3

0.36 ± 0.08

–

–

[16]

Singapore, Malaysia

Malays (urban)

169

15–74 years

6.3 ± 1.3

0.38 ± 0.08

–

–

[17]

Lenggong, Malaysia

Malays (rural)

35

15–74 years

7.1 ± 1.5

0.42 ± 0.09

–

–

[17]

Taiwan

Aborigines

145

–

7.9 ± 1.7

0.47 ± 0.10

53.8

11.7

[29]

Taiwan

Taiwanese Aborigines and Han Chinese

1,348

>18 years

6.7

0.40

26.1

3.3

[93]

Mainland Asia

India

Indians (rural)

85

20–70 years

5.3 ± 1.7

0.31 ± 0.10

–

–

[112]

Tirupati, India

Indians (urban)

97

20–70 years

6.1 ± 2.0

0.36 ± 0.12

–

–

[112]

Lhasa City, Tibet, China

Tibetans

1,289

>18 years

6.9 ± 1.6

0.41 ± 1.0

–

–

[113]

Beijing, China

Han Chinese (rural)

558

40–58 years

5.6 ± 1.3

0.33 ± 0.08

11.3

–

[114]

Beijing, China

Han Chinese (urban)

1,062

40–58 years

5.8 ± 1.3

0.34 ± 0.08

15.4

–

[114]

Qingdao, China

Han Chinese

903

20–74 years

6.5

0.39

32.1

–

[115]

Hangzhou, China

Han Chinese

186

“adults”

5.5 ± 1.2

0.33 ± 0.07

11

–

[116]

Vancouver, Canada

Canadian Chinese

100

–

5.4 ± 1.1

0.32 ± 0.06

–

–

[117]

Korea

Koreans

22,698

30–77 years

5.8 ± 1.6

0.35 ± 0.10

–

–

[118]

Nagano Prefecture, Japan

Japanese

15,712

>15 years

5.8 ± 1.1

0.35 ± 0.06

–

–

[119]

Okinawa, Japan

Japanese

6,163

18–89 years

6.5 ± 1.3

0.39 ± 0.08

34.5

–

[120]

Hawaii, USA

Japanese Americans

7,971

45–69 years

6.0 ± 1.5

0.36 ± 0.09

–

–

[121]

Thailand

Thai

376

–

6.0 ± 1.4

0.36 ± 0.08

18.4

–

[122]

Americas

Vancouver, Canada

Caucasian Canadians

200

–

4.6 ± 1.0

0.27 ± 0.06

–

–

[117]

Canada

Haida (Amerindians)

236

–

4.4 ± 1.0

0.26 ± 0.06

–

–

[117]

Tecumeseh, Michigan, USA

Caucasian Americans

2,987

>3 years

4.9 ± 2.0

0.29 ± 0.12

7.5

–

[123]

New England, USA

Caucasian Americans

534

>20 years

6.4 ± 1.4

0.38 ± 0.08

–

–

[124]

NHANES Cohort, USA

Americans of multiple ancestral backgrounds

8,816

>20 years

6.1

0.36

21.2

5.9

[125]

Montana, USAa

Blackfeet (Amerindians)

1,018

–

4.9 ± 1.2

0.29 ± 0.07

7.17

–

[126]

Arizona, USAa

Pima (Amerindians)

949

–

4.2 ± 1.2

0.25 ± 0.07

3.27

–

[126]

Arizona, USA

“American Indians”

–

>18 years

5.7 ± 1.4

0.33 ± 0.08

–

–

[127]

Dakotas, USA

“American Indians”

–

>18 years

6.1 ± 1.5

0.36 ± 0.09

–

–

[127]

Oklahoma, USA

“American Indians”

–

>18 years

6.1 ± 1.4

0.36 ± 0.08

–

–

[127]

USA

American Army Recruits

2,084

–

4.9

0.29

–

–

[128]

Colombia

Colombian Army Recruits

481

–

5.0

0.30

–

–

[128]

Argentina

Argentinian Army Recruits

491

–

4.8

0.29

–

–

[128]

Brazil

Brazilian Army Recruits

1,990

–

4.1

0.24

–

–

[128]

Brazil

Parkatêjê (Amerindians)

53

20–80 years

5.8 ± 0.9

0.34 ± 0.05

5.6

–

[129]

Brazil

Kalapalo (Amerindians)

53

20–80 years

5.1 ± 1.3

0.30 ± 0.07

3.2

–

[130]

Brazil

Kuikuro (Amerindians)

54

20–80 years

4.6 ± 1.0

0.27 ± 0.06

0

–

[130]

Brazil

Matipo (Amerindians)

5

20–80 years

5.1 ± 0.9

0.30 ± 0.05

0

–

[130]

Brazil

Nahukwá (Amerindians)

13

20–80 years

4.5 ± 1.0

0.27 ± 0.06

0

–

[130]

Europe

Birmingham and Dorset, England

English

512

>15 years

5.5 ± 1.0

0.33 ± 0.06

6.6

–

[131]

Cotwolds, England

English

1,727

>35 years

5.1 ± 1.4

0.30 ± 0.08

6.75

1.68

[132]

Watford, England

English

158

>15 years

5.0 ± 1.2

0.30 ± 0.07

–

–

[124]

Wensleydale, England

English (rural)

435

>15 years

4.7 ± 0.9

0.28 ± 0.05

–

–

[124]

Glasgow, Scotland

Scottish (urban)

337

>15 years

5.5 ± 1.0

0.33 ± 0.06

8.0

–

[131]

Finland

Finnish

3,295

40–69 years

5.1 ± 1.2

0.30 ± 0.07

6.6

–

[133]

France

French

23,923

20–55 years

5.9 ± 1.2

0.35 ± 0.07

17.6

–

[134]

Austria

Austrians

83,683

>18 years

5.7 ± 1.4

0.34 ± 0.08

–

–

[135]

Izmir, Turkey

Turks (urban)

63

“Adult”

5.5 ± 1.3

0.33 ± 0.07

19.0

–

[136]

Middle East

Israel

Israelis

9,909

>40 years

4.8 ± 1.0

0.28 ± 0.06

–

–

[137]

Jordan

Jordanians

96

18–60 years

5.7 ± 1.1

0.35 ± 0.07

–

–

[138]

Syria

Syrians

1,042

20–60 years

5.2 ± 1.2

0.31 ± 0.07

–

–

[139]

Kuwait

Kuwait

110

20–40 years

4.7 ± 0.9

0.28 ± 0.05

–

–

[140]

Kuwait

Kuwait

79

>20 years

5.5 ± 1.4

0.33 ± 0.08

–

–

[141]

Saudi Arabia

Saudis

278

14–65 years

5.2 ± 1.0

0.31 ± 0.06

–

–

[142]

Saudi Arabia

Saudis

250

14–83 years

5.2 ± 1.5

0.31 ± 0.09

8

–

[143]

Africa

Phokeng, South Africa

Tswana (rural)

128

14–84 years

4.9 ± 1.9

0.29 ± 0.11

–

–

[144]

Soweto, South Africa

Tswana, Zuli and Xhosa (urban)

144

15–90 years

6.1 ± 1.4

0.36 ± 0.08

–

–

[145]

Transkei, South Africa

Xhosa (tribal)

80

>15 years

4.7 ± 1.1

0.28 ± 0.06

–

–

[146]

South Africa

“Africans”

87

“Adult”

5.9 ± 1.5

0.35 ± 0.09

–

–

[147]

South Africa

Caucasians

121

“Adult”

6.7 ± 1.6

0.40 ± 0.10

–

–

[147]

Zairea

“Zairois”

75

–

5.6 ± 1.1

0.33 ± 0.06

–

–

[148]

Kinshasa, Zairea

“Zairois” (urban)

100

–

5.7 ± 1.2

0.34 ± 0.07

–

–

[148]

Kasongo-Batetela, Zaire

“Zairois” (rural)

33

–

5.5 ± 1.1

0.33 ± 0.06

–

–

[148]

Zairea

Caucasians

19

–

5.4 ± 1.1

0.32 ± 0.06

–

–

[148]

Zambia

Zambians

50

–

5.2 ± 1.5

0.31 ± 0.09

–

–

[149]

Mbeya, Tanzania

Tanzanians (mixed tribes)

137

19–48 years

5.3

0.32

–

–

[150]

Seychelles

Seychellois

482

25–64 years

6.9 ± 2.8

0.41 ± 0.17

35.2

–

[33]

Sudan

Sudanese

16

20–22 years

4.3 ± 0.2

0.26 ± 0.01

–

–

[67]

  1. aMean SU value and prevalence of hyperuricaemia is for a mixed male and female sample

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Gosling, A.L., Matisoo-Smith, E. & Merriman, T.R. Hyperuricaemia in the Pacific: why the elevated serum urate levels?. Rheumatol Int 34, 743–757 (2014). https://doi.org/10.1007/s00296-013-2922-x

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