Reprinted from
ARTHRITIS AND RHEUMATISM
Vol. 27, No. 6, June 1984
apna
© 1984 The Arthritis Foundation
401819
Printed in U.S.A.
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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.
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