Association between dietary approaches to stop hypertension (DASH) diet and hyperuricemia among Chinese adults: findings from a nationwide representative study

**Background:** Hyperuricemia (HUA) is a metabolic disease caused by uric acid metabolism disorder or impaired renal excretion. It is the main pathogenic factor for gout and may contribute to hypertension, type 2 diabetes, chronic kidney disease, metabolic syndrome, and cardiovascular disease. In China, HUA prevalence rose from 8.4% to 14% between 2009 and 2019. While individual dietary components affect serum uric acid (SUA), evidence on holistic dietary strategies for HUA prevention remains limited. The Dietary Approaches to Stop Hypertension (DASH) diet—rich in fruits, vegetables, low-fat dairy, nuts, legumes, and whole grains while limiting saturated fat and sugar—has shown promise in reducing SUA in U.S. intervention studies, but evidence in general Chinese populations is scarce.

**Methods:** Data were from the China Adult Chronic Disease and Nutrition Surveillance (CACDNS) 2015, a nationally representative cross-sectional study using multistage stratified cluster random sampling across 31 Chinese provinces. After excluding participants with implausible energy intakes (n=2,169), pregnant women (n=141), cancer patients (n=1,019), and nursing mothers (n=153), 66,427 adults (31,920 men, 34,507 women) were included. Dietary intake was assessed via a 3-day food record (two weekdays, one weekend day) and a 3-day household condiment weighing method. The DASH score (0-9) was calculated using the Mellen et al. formula based on nine nutrients: total fat, saturated fat, calcium, protein, potassium, cholesterol, magnesium, fiber, and sodium. SUA was measured using the Hitachi Automatic Platform 7600. HUA was defined as SUA ≥7.0 mg/dL in men or ≥6.0 mg/dL in women. Multiple linear and logistic regression models were used, adjusting for age, sex, BMI, region, ethnicity, marital status, education, physical activity, smoking, alcohol consumption, NCDs status, medication use, and urologic disease.

**Key Results:** The overall prevalence of HUA was 14% (18% in men; 10.3% in women). Participants in the highest DASH score quartile (Q4) had lower SUA levels compared to the lowest quartile (Q1). After full adjustment (Model 2), each unit increase in DASH score was associated with lower SUA levels (β = -0.11; 95% CI: -0.12, -0.1; p < 0.001) and lower odds of HUA (OR = 0.85; 95% CI: 0.83, 0.87; p < 0.001). Compared to Q1, the ORs for HUA in Q2, Q3, and Q4 were 0.88 (0.83, 0.94), 0.72 (0.68, 0.76), and 0.65 (0.61, 0.69), respectively (P-trend < 0.001). The inverse association was stronger among men (p-interaction = 0.009), non-Han Chinese (p-interaction < 0.001), and rural residents (p-interaction < 0.001). No significant interactions were found for age group (p=0.723), BMI (p=0.372), or health status (p=0.762).

**Clinical Implications:** This study provides the first nationally representative evidence from China that higher DASH diet adherence is associated with lower SUA levels and reduced odds of HUA. The findings support the DASH diet as a holistic dietary strategy for HUA prevention, extending beyond its established role in hypertension management. The stronger effects observed in men, non-Han Chinese, and rural residents suggest potential for targeted dietary interventions. However, due to the cross-sectional design, causal relationships cannot be established, and longitudinal studies are needed. Cultural adaptation of the DASH diet for Chinese dietary habits—such as increasing calcium intake through beans and tofu rather than dairy—may enhance its applicability and effectiveness in the Chinese population.