Reprinted from ARTHRITIS AND RHEUMATISM Vol. 27, No. 6, June 1984 apna © 1984 The Arthritis Foundation 401819 Printed in U.S.A. repository Jo L. Pecoed Gg BRIEF REPORT : fslare COLLECTION ll || ' 713 goxne HZMB FOLDER VA OL e (tm 5-134) OF kic HYPERURICEMIA IN THE INHABITANTS OF THE MARSHALL ISLANDS WILLIAM H. ADAMS, JAMES A. HARPER, PETER M. HEOTIS, and ABBE H. JAMNER Elevated serum uric acid (SUA) levels are common among Pacific populations, and modifying environmental factors have been investigated as a formed colorimetrically using the Technicon Auto of people living in the Marshall Islands, which are located in eastern Micronesia, and have found elevated values similar to those reported for other Micronesian populations (2-4). The nearly Gaussian distribu- Denis reagent (6). A modification of the biuret reaction cause for this finding (1). We have studied SUA levels tion of individual serum uric acid values for men, and for women-=45 years of age, indicates that the elevation is due to a regularized increase in serum uric acid rather than to a subpopulation that has pathologic hyperuricemia. The higher serum uric acid levels appear, therefore, to be normal for the Marshallese, a conclusion supported by the infrequency of clinical gout in the population tested. Patients and methods. Annual medical examina- tions are conducted by Brookhaven National Laboratory (BNL) for a population of Marshallese who were accidentally exposed to radioactive fallout in 1954, for a Comparison population, and for all inhabitants of the atolls of Rongelap and Utirik (5). Disease surveillance Analyzer J (Technicon Corp., Tarrytown, NY). The testing procedure for uric acid is based on a carbonate methodutilizing a phosphotungstate reaction of Folinwas used for total protein analysis. Serum protein electrophoresis was performed on a Quick Scan Electrophoresis Analyzer using Titan II] cellulose acetate plates (Helena Laboratories, Beaumont, TX). Albumin and globulin fractions were calculated by multi- plying the relative percents of each by the total protein and dividing by 100. Medical records were reviewed to extract pertinent clinical data, and individuals were classified according to diabetic status, blood pressure readings, and obesity at the time of SUA testing. The diagnosis of diabetes was based on World Health Organization guidelines (7). An individual was listed as hypertensive if a diastolic reading of 90 mm Hgor greater was noted on 2 occasions separated by an interval of at least 1 returned to BNL fortesting. In 1974 and 1977 SUA andserum proteins were determined for 384 Marshallese. Analyses were per- year. Obesity was estimated using the formula that divides weight in kilograms by the height in meters squared (the body mass index [BMI]). A value greater than 27 was considered an indication of obesity (8). Clinical entries were reviewed for recorded evidence of gout, defined as acute, recurrent monarticular arthritis, at the time of, and 5 years subsequent to, SUA From the Medical Department, Brookhaven National Laboratory, Upton, New York. William H. Adams, MD; James A. Harper, MD: Peter M. Heotis, MPS; Abbe H. Jamner, MS. Because of their remoteness, those people living on Rongelap and Utirik atolls tend to be traditional in includes analysis of serum samples, which are collect- ed, frozen within a few hours of collection, and Address reprint requests to William H. Adams, MD, Medical Department, Brookhaven National Laboratory, Upton, NY 11973. Submitted for publication May 17, 1983; accepted in revised testing. : Virtually all subjects resided on 1 of 4 islands. customs, diet, and economy. Loca! foods (fish, bread- fruit, pandanus, and coconut) are, however, heavily supplemented by foods supplied by the U.S. Depart- form January 19, 1984. ’ ment of Agriculture (rice, canned meats), and import- Arthritis and Rheumatism, Vol. 27, No. 6 (June 1984) The Medical Research. Center el 3 fj * 2 gk a eg i UU Brookhaven National Lab er alg ry Upton, L. 1, New York