In addition to ethanol content, alcoholic beverage type is a contributing factor to serum urate levels, a new study finds.

In a study of 78,153 Japanese adults (46.7% men) undergoing routine medical checkups, 45,755 (58.5%) regularly consumed alcoholic beverages. Among both men and women, regular drinkers had higher serum urate levels compared with infrequent drinkers, across alcoholic beverage types.

In adjusted analyses using β coefficients, each 1-unit increase in daily alcohol consumption (containing 20 g ethanol) was significantly associated with a 0.10 and 0.14 mg/dL increase in serum urate levels in men and women, respectively, Sho Fukui, MD, MPH, of Immuno-Rheumatology Center, St Luke’s International Hospital in Tokyo, Japan, and colleagues reported in JAMA Network Open. Each 1-unit increase in beer consumption significantly increased serum urate levels by 0.12 and 0.21 mg/dL in men and women, respectively. Each 1-unit intake of whiskey significantly increased serum urate levels by 0.19 and 0.16 mg/dL, respectively. Wine significantly increased serum urate levels by 0.10 mg/dL for each 1-unit increase in consumption in both sexes. Each 1-unit increase in shochu intake significantly increased serum urate levels by 0.08 and 0.09 mg/dL, respectively. Each 1-unit consumption of sake significantly increased serum urate levels by 0.06 mg/dL in men, but was not significantly associated with serum urate levels in women.

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Among a subset of patients who predominantly drank beer, each standard drink of beer consumed per day (500 mL) was significantly associated with a serum urate increase of 0.14 and 0.23 mg/dL in men and women, respectively.

“Higher beer consumption among men and women was consistently associated with higher serum urate levels, whereas sake was not associated with changes in serum urate levels,” Dr Fukui’s team wrote. “Therefore, alcoholic beverage type, in addition to ethanol content, should be considered as a factor contributing to hyperuricemia.”

Ethanol increases uric acid production and decreases the elimination of uric acid in urine by modulating kidney tubule function, the investigators explained. Other ingredients in alcoholic beverages such as purines can also affect serum urate levels. Beer contains the highest amount of purines, while other beverages include small amounts.

At baseline, less than 15% of adults had hypertension, diabetes, or chronic kidney disease – known contributors to hyperuricemia. All models adjusted for these and other relevant factors. Heavy drinkers were excluded from this study.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Fukui S, Okada M, Rahman M, et al. Differences in the association between alcoholic beverage type and serum urate levels using standardized ethanol content. JAMA Netw Open. Published online March 17, 2023. doi:10.1001/jamanetworkopen.2023.3398