BACKGROUND Increased serum uric acid (hyperuricemia) is a metabolic disorder that is closely related to a series of chronic non-infectious diseases such as myocardial infarction, stroke, diabetes, gout This topic has attracted authors interested but new researches just focused on big cities and in hospitals Currently there are no adequate studies in epidemiology increased serum uric acid and prevention in the community Meanwhile, scientific evidence has shown the effectiveness of intervention programs in the community in reducing the risk of death from diseases related to metabolic disorders Thai Binh is a province in the Northern Delta where there is also a transition of disease patterns Therefore, early detection and control the increase in serum uric acid without clinical manifestations are essential to help reduce the risk of some chronic non-infectious diseases At the same time, the identification of factors related to the scientific basis for the selection of appropriate and specific community interventions.As the theory of increased serum uric acid with metabolic disorders in rural areas is becoming a significant issue of public health and the consultancy of suitable diet will help control the serum uric acid level, the thesis has been carried out with objectivess as follows: Describing the current status of serum uric acid levels in people at the age of 30 and older in rural community in Thai Binh Identifying factors related to the condition in serum uric acid levels in the study area Assessing the intervention effects of dietary for people increased serum uric acid in the community New contributions of the Dissertation - Giving an abundant database in serum uric acid levels which were analyzed in collaboration with a number of indexes of anthropometry, blood pressure and blood lipids in people over 30 years old in rural communities in Thai Binh It first came up with the rate of increased serum uric acid which was not managed or cared in community, this helped warn a number of groups who often have a high risk of increased serum uric acid including obese and overweight group, big waist, high WHR index, a history of heart disease - Through multivarible correlation analysis, logistic regression analysis using Bayesian methods the study helped build models to predict serum uric acid levels by age, sex, BMI, abdominal obesity; detect factors independently associated with age, BMI, regular use of red meat, organ meats, bone water, alcohol in males; the independent factors associated with age, BMI, regular use of red meat, organ meats in females - Proved that "Nutrition communication, counseling for subjects to perform reasonable diet as the sample menu based on the actual diet and locally available food sources" has been remarkably effective in reducing serum uric acid concentration and reducing serum uric acid levels Layout of the thesis The dissertation consists of 130 pages, 30 tables, 12 charts and 153 references including 106 foreign ones Background has pages, 37 page literature review, research methodology 23 pages, 34 page research results, discussion 31 pages, page conclusions and page recommendations CHAPTER I LITERATURE REVIEW Studies on increased serum uric acid levels Cohort study follow-up data of Medicine for 50 years showed that if the 1954 -1958 period, the average serum uric acid levels was mg / dl in males and 3,9mg / dl in females, in the 1972 -1976 period, the average level rose 5,7mg / dl in men and 4,7mg / dl in women Australian researches showed that the rate of increased serum uric acid and gout accounted for high percentage compared to some countries in the region with similar economic conditions The rate of increased uric acid increased quickly in 1959 compared with 1980 (17% in men aged 30-40) in the original Australian populations Correspondingly, the incidence of gout increased from 0% in 1965 to 9.7% in men and 2% of women in 2002 Chuang's study evaluated trends in serum uric acid levels in Taiwan adults in two phases from 1993 to 1996 and from 2005 to 2008 showed a different trend Period 1993-1996, average uric acid levels were 6,77mg / dl in males and 5,33mg / dl in females, this value was reduced to 6,59mg / dl in men and 4,97mg / dl in women after 12 years The increased uric acid ratio decreased from 25.3% to 22% in men and from 16.7% to 9.7% in women, respectively This was explained by the change in diet which reduces consumption of organs, fresh bamboo shoots and fresh water use In Vietnam, the investigation on the subject who were military staff at the middle-aged in 1999, the rate of increased serum uric acid was 17.96% Doan Thi Tuong Vi studied the group which had a periodic health examination at the hospital 19/8, said men aged 30-60 with hyperuricemia was 6.2%, women 2.5%; the overall incidence was 4.9% Related factors were frequency of consumption of foods rich in protein and much alcohol, weight and high BMI The people with increased serum uric acid were at risk for hypertension, cholesterol, serum triglycerides higher than normal Phan Van Hop carried out research in the elderly in Nam Dinh in 2011 showed that the rate of increased serum uric acid was 9.5%, of which 16.3% in male, 5.5% female, group aged 60-90 was10.1%, group aged 70-79 was 9.7% and over 80 years was 8.1% Le Van Doan's research on subjects of middle-aged military officers in the military zone showed the percentage of increased serum uric acid was 26.2%, and the incidence tends to increase with age Factors related to increased serum uric acid levels were age, high protein diet, hypertension, dyslipidemia, overweight and obesity Factors related to serum uric acid levels The relevant factors have been reported from domestic and foreign studies included age, male gender, racial factors, genetics and gene mutations, diet, physical activity, nutritional status, puppets hyperlipidemia, hypertension, renal disease, cardiovascular disease and other chronic non-infectious diseases Many studies have identified the clear relationship between the state of increased serum uric acid with a number of non-infectious chronic diseases especially cardiovascular diseases such as heart failure, myocardial infarction, stroke Increased serum uric acid was found in approximately 60% of patients hospitalized with decompensated chronic heart failure Increased serum uric acid linked to insulin resistance status, hypoxic tissue, increases the production of cytokines and free radicals so they could affect the cardiovascular system and prognosis in these patients deteriorate The risk of hypertension also significantly higher in patients with increased serum uric acid of above 400μmol/l compared with those with serum uric acid below 200μmol/l Among patients with untreated hypertension, deterioration phenomenon of coronary artery blood flow in people with increased serum uric acid levels was higher than people with normal serum uric acid A number of studies have given evidence that theere was the combination between increased cholesterol, increased triglycerides and serum uric acid Up to 80% of the triglycerides increased people may increase serum uric acid and up to 50-70% of gout patients have triglycerides increased Intervention methods to decrease serum uric acid - Use of drugs: In the case of asymptomatic hyperuricemia, drug should be used only when the serum uric acid level is too high, above 12mg / dl (700 μmol / l) or when there is an increase in the level of acute uric acid production The regularly tested cases with hyperuricemia over 10 mg / dl which resists to dietary adjustments, or have a family history of gout, kidney stones with increase serum uric acid, signs of kidney damage are required to take drugs to reduce uric acid - Control of nutritional status: Many studies have shown that increased serum uric acid is related to obesity, overweight, diabetes, lipid disorders, metabolic syndrome This relationship is in general illness of Insulin resistance syndrome which is essentially due to the excessive accumulation of fat cells Therefore, to reduce the risk of chronic non-infectious diseases in general, it is necessary to maintain a weight level with ideal body mass index of 21-23 This is one of independent recommendations of the World Cancer Research Fund and American Institute for Cancer Research published in 2007 A number of studies have recommended, in obese people, if weight is well controled, it will help reduce serum uric acid similar to implementing a low-purine diet - Control diet: The increased serum uric acid is closely linked to diet Most uric acid in the body is derived from the metabolism of endogenous purine but diets with purine foods of animal origin may cause increased serum uric acid, because over 50% purine of ARN and 20% of ADN derived from food Therefore, the cases of increased serum uric acid should reduce the consumption of alcohol, soft drinks and fructose, reduce consumption of products of animal origin rich in purines, increase the use of vegetables, fruits, milk and supplement vitamin C CHAPTER METHODOLOGY 2.1 Study participants Stage 1: First investigation among people aged 30 and older Stage 2: Interventional study within months among people with increase in serum uric acid The control group was at communes as Minhkhai and Songlang; the interventional group was at Tanphong and Viethung 2.2 Methodology 2.2.1 Study design a Stage 1: Cross-sectional descriptive study in order to: - Describe mean of serum uric acid concentration and increase serum uric acid rate in relation to age group, gender, nutritional situation, level of physical activities - Identify some factors related to serum uric acid concentration and rate of increase serum uric acid as: gender, age, overweight, obesity, waist circumference, waist-hip ratio, hypertension, high blood glucose, blood lipid metabolic disorders, use of alcohol drink, food consumption b Stage 2: Community interventional study with control: People with increase in serum uric acid levels were divided into two groups of interventional and control groups, we followed up along month period to evaluate the effectiveness of dietary intervention on serum uric acid levels Evaluation results were taken times before and after intervention Interventions: Method 1: Mass media on nutrition Training people with increased serum uric acid content includes general knowledge about the consequences of increased serum uric acid, advice on diet to people with increase in serum uric acid focusing on the selection and use properly of common food sources available locally Organize training in CHCs one time each three months The first time is at the start of the intervention (M0), the second time was at months after conducting research Compiled communication materials "Community Guidelines for Prevention of Gout," and each object was distributed this document after the first training Method 2: Nutrition counseling We based on dietary habits, dietary practice, based on the source of food and nutrition habits of the local people to build and provide menus for a week, a month participants We developed menus for people with increase in serum uric acid based on nutritional needs for Vietnamese recommended by gender, age, level of physical activity, nutritional status, medical history and based on actual portions of objects Energy build must ensure a stable weight for people with normal weight, creating cumulative positive energy with the thin and energy reduction with overweight people The menu was based on the principle of reducing the use of protein, especially animal protein, animal protein accounted for approximately 30% The recommended dietary protein level 1g / kg / day and 12-14% to meet energy needs Demand for lipid occupies 20-25% of total energy We performed nutritional counseling time / month for months Control group: Applying nutritional communication approaches Intervention group: Apply both nutrition communication approaches and monthly nutritional counseling, as well as dietary building for participants 2.2.2 Sampling procedure and sample size + Identify the percentage of increase in serum uric acid and related factors: combining some sampling method, randomly selected communes of Vuthu District and make a list to randomly selected subjects with proper age by R software, sample sizes was as follows: p(1  p) n  Z (2  / ) (p) (Formula 1) The sample size for the cross-sectional survey as calculated was 1727 participants, in reality we has studied among 1910 people + Intervention study: we used intentionally sampling to select all the object with increase in serum uric acid levels Sample size applied for an interventional group as follows: nZ ( , ) 2s ( 1  2 ) (Formula 2) We calculated the minimum sample size of 68 subjects / group In reality we has taken all eligible subjects included 77 subjects in intervention group and 72 subjects in control group to participate in the study 2.2.3 Techniques applied to the study Assessment of nutritional status through BMI, waist circumference, waist/hip circumference Investigation dietary of the last 24 hours, interview to determine the frequency of food consumption, eating habits, medical history, physical examination, blood pressure, blood biochemistry tests 2.2.4 Data processing Data were analyzed using R software We calculated average value, the ratio, percentage, the statistical test applied in biomedical research to analyze the results Odds ratio OR was calculated to evaluate the factors related to the increase in serum uric acid levels We used multivariate linear regression and logistic regression to identify associated factors, to exclude of confounding factors and to identify interaction effects The study used a Bayesian method to select the optimal model for multivariate analysis 2.2.5 Ethical consideration The study complied with the Declaration of Helsinki of the World Medical Association on ethical issues in Biomedical Research The research proposal was adopted Council Ethics in Biomedical Research at the National Institute of Hygiene and Epidemiology before conducting research Research ensured the voluntary participation of subjects Safety issues and benefits of the study subjects had been assured during the research process Chapter III RESULTS 3.1 Situation of increasing in serum uric acid among people aged 30 and older at rural ThaiBinh Table 3.1 Socio-demographic characteristics of participants male female total Age group (n=935) (n=975) (n=1.910) n % n % n % 30-39 118 12.6 121 12.4 239 12.5 40-49 165 17.6 178 18.2 343 18.0 50-59 246 26.3 254 26.1 500 26.2 60-69 245 26.2 254 26.1 499 26.1 70-79 124 13.3 127 13.0 251 13.1 80 + 37 4.0 41 4.2 78 4.1 total 935 49.0 975 51.0 1910 100.0 Occupation Farmer 696 74.4 851 87.3 1547 81.0 Worker 148 15.8 52 5.3 200 10.5 businessman 43 4.6 24 2.5 67 3.5 Civil servant 32 3.4 36 3.7 68 3.6 Other 16 1.7 12 1.2 28 1.4 Table 3.1 showed that in total of 1.910 participants, male was accounted for 49.0% Participants were distributed based on age groups were gender equally 350 Uric acid (micromol/l) 50 150 250 male female 30-39 40-49 50-59 60-69 Age group 70-79 80+ Figure 3.2 Average serum uric acid concentration based on age group and gender Figure showed that average serum uric acid concentrations were not different between genders between age group of 30-39 and 40-49 However, after 50 years old, the concentration increased with age and reached the highest at age group of 80 and more The difference was significant at p