Background
Methods
Study design and participants
Questionnaire development
Statistical analysis
Results
Characteristics of the study population
n (%) | Knowledge | Attitude | Practice | ||||
---|---|---|---|---|---|---|---|
Median (P25, P75) | P | Median (P25, P75) | P | Median (P25, P75) | P | ||
Total | 1288 | 16 (12, 19) | 22 (20, 24) | 27.5 (23, 31.75) | |||
Gender | 0.141 | 0.403 | 0.225 | ||||
Male | 559 (43.4) | 16 (11, 19) | 22 (20, 24) | 27 (23, 31.5) | |||
Female | 729 (56.6) | 16 (12, 20) | 22 (20, 24) | 28 (23, 32) | |||
Age | 0.145 | < 0.001 | < 0.001 | ||||
< 15 years | 2 (0.2) | 9.5 (9, 10) | 19 (18, 20) | 20.5 (14, 27) | |||
15–18 years | 11 (0.9) | 14 (10, 17) | 22 (21, 24) | 28 (23, 32) | |||
19–25 years | 270 (21.0) | 16 (12, 19) | 21 (19, 23) | 25.25 (21, 30) | |||
26–30 years | 296 (23.0) | 16 (13, 19) | 22 (20, 23.5) | 28 (23.5, 32) | |||
31–35 years | 249 (19.3) | 16 (12, 19) | 22 (20, 24) | 28 (24, 32) | |||
36–40 years | 296 (23.0) | 16 (12, 20) | 22 (20, 24) | 27 (23, 31.75) | |||
41–44 years | 164 (12.6) | 15 (11.5, 20) | 23 (21, 25) | 29 (24.5, 33.5) | |||
Education | < 0.001 | 0.790 | 0.025 | ||||
Primary school | 1 (0.1) | 9 (9, 9) | 20 (20, 20) | 27 (27, 27) | |||
Junior high school | 33 (2.6) | 10 (8, 13) | 22 (20, 25) | 24.5 (21, 28) | |||
High school | 50 (3.9) | 14 (10, 17) | 22 (20, 24) | 25.75 (21, 31) | |||
Bachelor’s/associate’s | 731 (56.8) | 16 (12, 19) | 22 (20, 24) | 27.5 (23, 31.5) | |||
Postgraduate and above | 473 (36.6) | 16 (13, 20) | 22 (20, 24) | 28 (23, 32) | |||
Occupation | < 0.001 | < 0.001 | < 0.001 | ||||
Student | 203 (15.8) | 15 (11, 18) | 21 (20, 23) | 25 (21, 30) | |||
White-collar/employee | 476 (37.0) | 14 (11, 18) | 22 (20, 24) | 27 (23, 30.75) | |||
Educator | 75 (5.8) | 16 (11, 19) | 22 (20, 24) | 28.5 (23, 33) | |||
Healthcare worker | 349 (27.1) | 19 (16, 21) | 22 (20, 24) | 30 (25.5, 33) | |||
Other | 185 (14.3) | 15 (11, 18) | 22 (21, 24) | 27 (22.5, 31.5) | |||
Are you the only child? | 0.012 | 0.964 | 0.004 | ||||
Yes | 600 (46.6) | 17 (13, 20) | 22 (20, 24) | 28 (24, 32) | |||
No | 688 (53.4) | 16 (11, 19) | 22 (20, 24) | 27 (23, 31.5) | |||
Weight status | 0.002 | 0.009 | 0.003 | ||||
Underweight | 145 (11.3) | 15 (10, 18) | 21 (20, 23) | 25 (21.5, 30.5) | |||
Normal weight | 601 (46.7) | 16 (12, 19) | 22 (20, 24) | 28 (24, 32) | |||
Overweight | 380 (29.5) | 16 (12, 19) | 22 (20, 24) | 27.25 (23, 32) | |||
Obese | 162 (12.5) | 17 (13, 20) | 22 (20, 25) | 27.5 (24, 32) | |||
Do you suffer from hyperuricemia? | < 0.001 | < 0.001 | < 0.001 | ||||
Yes | 253 (19.6) | 19 (15, 20) | 23 (21, 25) | 30.5 (26.5, 33.5) | |||
No | 1035 (80.4) | 15 (11, 19) | 22 (20, 24) | 27 (22.5, 31) | |||
Do you suffer from gout? | < 0.001 | < 0.001 | < 0.001 | ||||
Yes | 183 (14.2) | 18 (15, 20) | 23 (21, 25) | 29.5 (26, 34) | |||
No | 1105 (85.8) | 16 (12, 19) | 22 (20, 24) | 27 (23, 31) |
Knowledge, attitudes, and practices scores
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
---|---|---|---|
Have you heard of hyperuricemia? | 936 (72.7) | 262 (20.3) | 90 (7.0) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Are you aware of the triggering factors of hyperuricemia? | 605 (47.0) | 483 (37.5) | 200 (15.5) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Do you comprehend the risks associated with hyperuricemia? | 662 (51.4) | 467 (36.3) | 159 (12.3) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Is the intake of sugary beverages related to hyperuricemia? | 762 (59.2) | 41 (3.2) | 485 (37.6) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Is fructose in sugary beverages a significant factor in causing hyperuricemia? | 603 (46.8) | 56 (4.4) | 629 (48.8) |
a. Yes (0 points) | b. No (1 point) | c. Uncertain (0 points) | |
Are low purine levels in sugary beverages unlikely to cause hyperuricemia? | 110 (8.5) | 607 (47.1) | 571 (44.4) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Is hyperuricemia closely related to the onset of gout? | 925 (71.8) | 16 (1.3) | 347 (26.9) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Does hyperuricemia increase the risk of developing diabetes? | 722 (56.0) | 32 (2.5) | 534 (41.5) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Can severe hyperuricemia lead to acute kidney failure? | 840 (65.2) | 15 (1.2) | 433 (33.6) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Are you familiar with beverages that have high sugar content? | 885 (68.7) | 131 (10.2) | 272 (21.1) |
a. Yes (0 points) | b. No (1 point) | c. Uncertain (0 points) | |
Is consuming sugar-free beverages, which substitute white sugar, brown sugar, cane sugar, glucose, etc., with “artificial sweeteners” on the market, therefore, have no impact on human health? | 147 (11.4) | 883 (68.6) | 258 (20.0) |
a. Yes (1 point) | b. No (0 points) | c. Uncertain (0 points) | |
Do calorie-free, sugar-free carbonated beverages increase the risk of hyperuricemia? | 461 (35.8) | 164 (12.7) | 663 (51.5) |
Item | Option | n (%) |
---|---|---|
Which of the following are common sugary beverages? (Multiple choices allowed) | a. Cola/Sprite | 1246 (96.7) |
b. Fruit juice drinks | 1190 (92.4) | |
c. Bubble tea | 1223 (95.0) | |
d. Americano coffee | 283 (22.0) | |
e. Sports drinks (e.g., Red Bull, Powerade) | 896 (69.6) | |
f. Tea-based drinks (e.g., Kangshifu green tea, iced black tea) | 902 (70.0) | |
g. Uncertain | 11 (0.9) | |
What are the potential harms of sugary beverages to the human body? (Multiple choices allowed) | a. Obesity | 1263 (98.1) |
b. Tooth decay | 1175 (91.2) | |
c. Cardiovascular diseases | 1108 (86.0) | |
d. Hyperuricemia | 995 (77.3) | |
e. Accelerated aging | 1024 (79.5) | |
f. Uncertain | 12 (0.9) |
a. Significantly impactful (5 points) | b. Moderately impactful | c. Uncertain | d. Not very impactful | e. No impact at all (1 point) | |
---|---|---|---|---|---|
What do you believe is the impact of frequent consumption of sugary beverages on health? | 671 (52.0) | 515 (40.0) | 69 (5.4) | 29 (2.3) | 4 (0.3) |
a. Numerous factors contribute to hyperuricemia, and sugary beverages are insignificant (1 point) | b. Numerous factors contribute to hyperuricemia, and sugary beverages play a role | c. Uncertain, varies by individual | d. Excessive sugary beverage intake might be a factor leading to hyperuricemia | e. Excessive sugary beverage intake is a significant factor causing hyperuricemia (5 points) | |
Do you think the occurrence of hyperuricemia is related to the consumption of sugary beverages? | 66 (5.1) | 529 (41.1) | 318 (24.7) | 213 (16.5) | 162 (12.6) |
a. Strongly agree 1 point) | b. Somewhat agree | c. Uncertain | d. Somewhat disagree | e. Strongly disagree (5 points) | |
Do you think you are in good health and unlikely to develop hyperuricemia easily? | 100 (7.7) | 238 (18.5) | 407 (31.6) | 363 (28.2) | 180 (14.0) |
a. Very concerned, harmful to health (5 points) | b. Concerned, affects health | c. Neutral | d. Not very concerned, treatable | e. Completely unconcerned, a minor issue (1 point) | |
If you had hyperuricemia, would you be worried? | 446 (34.6) | 650 (50.5) | 140 (10.9) | 39 (3.0) | 13 (1.0) |
a. Strongly agree, sugary beverages are entirely harmful (5 points) | b. Agree, sugary beverages impact health | c. Neutral | d. Somewhat disagree, drinking a little is okay | e. Completely disagree, excessive consumption doesn’t have a big impact (1 point) | |
Do you think you should reduce the consumption of sugary beverages? | 465 (36.1) | 667 (51.8) | 110 (8.5) | 44 (3.4) | 2 (0.2) |
a. Very difficult to control, actively want to drink beverages (1 point) | b. Somewhat difficult to control, unintentionally consume (at social events, when thirsty) | c. Uncertain, depends on the situation | d. Can generally control | e. Can strictly control, constantly remind myself (5 points) | |
Do you find it challenging to control reducing or not drinking sugary beverages? | 150 (11.7) | 357 (27.7) | 113 (8.8) | 499 (38.7) | 169 (13.1) |
a. Influenced by people around me | b. Hot weather, drinking cold beverages for cooling | c. As afternoon tea, to replenish energy | d. Sold everywhere, convenient to purchase | e. Most beverages are sugary, can’t find non-sugar options | f. Good taste, mood regulation | g. Other | |
---|---|---|---|---|---|---|---|
What factors do you believe would make you choose sugary beverages? | 102(7.9) | 526(40.8) | 55(4.3) | 59(4.6) | 110(8.5) | 398(30.9) | 38(3.0) |
a. Yes (2.5 points) | b. No | c. Uncertain | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Have you paid attention to hyperuricemia? | 628 (48.8) | 594 (46.1) | 66 (5.1) | |||||||||
a. Yes (2.5 points) | b. No | c. Uncertain | ||||||||||
Have you paid attention to the relationship between sugar and hyperuricemia? | 419 (32.5) | 774 (60.1) | 95 (7.4) | |||||||||
a. Multiple times a day (1 point) | b. Once a day | c. Several times a week | d. Several times a month | e. Rarely or seldom drink sugary beverages (5 points) | ||||||||
How often do you consume sugary beverages? | 59 (4.6) | 137 (10.6) | 433 (33.6) | 379 (29.4) | 280 (21.8) | |||||||
a. Very inclined (5 points) | b. Moderately inclined | c. Uncertain | d. Not very inclined | e. Not inclined, only care about taste (1 point) | ||||||||
Are you more inclined towards sugar-free or low-sugar beverages when choosing drinks? | 464 (36.0) | 415 (32.2) | 109 (8.5) | 138 (10.7) | 162 (12.6) | |||||||
a. Frequently attentive (5 points) | b. Occasionally attentive | c. Uncertain | d. Not very attentive | e. Not attentive (1 point) | ||||||||
When purchasing beverages, do you pay attention to the ingredient list? | 391 (30.4) | 500 (38.8) | 38 (3.0) | 249 (19.3) | 110 (8.5) | |||||||
a. Tried and maintained for a long time (5 points) | b. Tried but only maintained for a short period | c. Tried but couldn’t control and ended up drinking | d. Haven’t tried | e. Not planning to or don’t want to reduce sugar beverage intake (1 point) | ||||||||
Have you attempted to reduce the consumption of sugary beverages? | 529 (41.1) | 370 (28.7) | 161 (12.5) | 197 (15.3) | 31 (2.4) | |||||||
a. Often advised by others | b. Occasionally advised by others | c. Rarely advised by others | d. Never advised by others | e. I don’t drink sugary beverages | ||||||||
Has anyone advised you to drink less sugary beverages? | 391 (30.4) | 495 (38.4) | 209 (16.2) | 100 (7.8) | 93 (7.2) | |||||||
a. I wouldn’t, relatively expensive and inconvenient (1 point) | b. Not really, a bit of a hassle | c. Uncertain, depends on the situation | d. Generally will, fresh-squeezed juice is fresher | e. Definitely will, health is most important (5 points) | ||||||||
Would you choose freshly squeezed juice over prepared fruit juice? | 210 (16.3) | 319 (24.8) | 343 (26.6) | 291 (22.6) | 125 (9.7) | |||||||
a. Not concerned, irrelevant to me (1 point) | b. Not very concerned, never heard of it | c. Uncertain | d. Occasionally concerned, might inadvertently see relevant reports | e. Frequently concerned, because I prioritize health (5 points) | ||||||||
Do you pay attention to news about the harm of sugary beverages to the human body? | 52 (4.0) | 178 (13.8) | 116 (9.0) | 731 (56.8) | 211 (16.4) | |||||||
a. No (5 points) | b. Rarely | c. Uncertain | d. Maybe, some beverages are relatively healthy | e. Yes, convenient to drink (1 point) | ||||||||
Does hyperuricemia requiring more urination lead you to drink more beverages for increased urination? | 650 (50.5) | 295 (22.9) | 207 (16.1) | 100 (7.8) | 36 (2.7) | |||||||
a. Soda | b. Milk | c. Fruit juice drinks | d. Energy drinks | e. Tea-based drinks | f. Water | g. Other | ||||||
What beverage do you tend to choose when thirsty? | 176 (13.7) | 42 (3.3) | 92 (7.1) | 48 (3.7) | 211 (16.4) | 666 (51.7) | 53 (4.1) |
Correlations
Knowledge | Attitude | Practice | |
---|---|---|---|
Knowledge | 1.000 | / | / |
Attitude | 0.326 (P < 0.001) | 1.000 | / |
Practice | 0.485 (P < 0.001) | 0.448 (P < 0.001) | 1.000 |
Univariable and multivariable analyses
Cut-off value: ≥16/<16 | n | Univariable | Multivariable (regression method: enter) | ||
---|---|---|---|---|---|
OR (95%CI) | P | OR (95%CI) | P | ||
Gender | |||||
Male | 294/559 | ref. | |||
Female | 405/729 | 1.127 (0.903, 1.406) | 0.290 | ||
Age | |||||
≤ 25years | 143/283 | ref. | |||
26–30 years | 173/296 | 1.377 (0.992, 1.912) | 0.056 | ||
31–35 years | 142/249 | 1.107 (0.820, 1.494) | 0.506 | ||
36–40 years | 160/296 | 0.949 (0.727, 1.239) | 0.699 | ||
41–44 years | 81/164 | 0.797 (0.574, 1.107) | 0.176 | ||
Education level | |||||
High school or below | 27/84 | ref. | ref. | ||
Bachelor/Associate | 402/731 | 2.580 (1.595, 4.171) | < 0.001 | 1.912 (1.128, 3.239) | 0.016 |
Postgraduate or above | 270/473 | 1.748 (1.293, 2.363) | < 0.001 | 1.286 (0.916, 1.805) | 0.146 |
Occupation | |||||
Student | 274/349 | ref. | ref. | ||
White-collar/employee | 197/476 | 0.193 (0.141, 0.265) | < 0.001 | 0.147 (0.105, 0.206) | < 0.001 |
Educator | 43/75 | 0.368 (0.218, 0.621) | < 0.001 | 0.300 (0.174, 0.518) | < 0.001 |
Healthcare worker | 100/203 | 0.266 (0.183, 0.387) | < 0.001 | 0.277 (0.188, 0.407) | < 0.001 |
Other | 85/185 | 0.233 (0.158, 0.342) | < 0.001 | 0.175 (0.115, 0.267) | < 0.001 |
Are you the only child? | |||||
Yes | 345/600 | ref. | ref. | ||
No | 354/688 | 0.783 (0.628, 0.977) | 0.030 | 0.824 (0.644, 1.054) | 0.123 |
Weight status | |||||
Underweight | 69/145 | ref. | |||
Normal weight | 320/601 | 1.254 (0.872, 1.804) | 0.221 | ||
Overweight | 209/380 | 1.202 (0.916, 1.577) | 0.184 | ||
Obese | 101/162 | 1.531 (1.083, 2.166) | 0.016 | ||
Do you suffer from hyperuricemia? | |||||
Yes | 189/253 | ref. | ref. | ||
No | 510/1035 | 0.329 (0.242, 0.448) | < 0.001 | 0.386 (0.253, 0.590) | < 0.001 |
Do you suffer from gout? | |||||
Yes | 134/183 | ref. | ref. | ||
No | 565/1105 | 0.383 (0.270, 0.542) | < 0.001 | 0.456 (0.282, 0.736) | 0.001 |
Cut-off value: ≥22/<22 | n | Univariable | Multivariable (regression method: enter) | ||
---|---|---|---|---|---|
OR (95%CI) | P | OR (95%CI) | P | ||
Gender | |||||
Male | 302/559 | ref. | |||
Female | 404/729 | 1.058 (0.848, 1.320) | 0.619 | ||
Age | |||||
≤ 25years | 118/283 | ref. | ref. | ||
26–30 years | 159/296 | 1.623 (1.168, 2.254) | 0.004 | 1.470 (1.052, 2.052) | 0.024 |
31–35 years | 146/249 | 1.556 (1.151, 2.102) | 0.004 | 1.489 (1.097, 2.022) | 0.011 |
36–40 years | 175/296 | 1.370 (1.046, 1.794) | 0.022 | 1.328 (1.010, 1.746) | 0.042 |
41–44 years | 108/164 | 1.689 (1.197, 2.382) | 0.003 | 1.548 (1.091, 2.198) | 0.014 |
Education level ) | |||||
High school or below | 50/84 | ref. | |||
Bachelor/associate | 395/731 | 0.799 (0.505, 1.265) | 0.339 | ||
Postgraduate or above | 261/473 | 0.936 (0.699, 1.255) | 0.659 | ||
Occupation | |||||
Student | 207/349 | ref. | |||
White-collar/employee | 255/476 | 0.792 (0.599, 1.047) | 0.101 | ||
Educator | 40/75 | 0.784 (0.475, 1.294) | 0.341 | ||
Healthcare worker | 85/203 | 0.494 (0.348, 0.702) | < 0.001 | ||
Other | 119/185 | 1.237 (0.855, 1.789) | 0.259 | ||
Are you the only child? | |||||
Yes | 328/600 | ref. | |||
No | 378/688 | 1.011 (0.812, 1.260) | 0.921 | ||
Weight status | |||||
Underweight | 71/145 | ref. | |||
Normal weight | 340/601 | 1.358 (0.944, 1.953) | 0.099 | ||
Overweight | 204/380 | 1.037 (0.790, 1.360) | 0.794 | ||
Obese | 91/162 | 1.133 (0.806, 1.591) | 0.472 | ||
Do you suffer from hyperuricemia? | |||||
Yes | 184/253 | ref. | ref. | ||
No | 522/1035 | 0.382 (0.282, 0.516) | < 0.001 | 0.512 (0.345, 0.760) | 0.001 |
Do you suffer from gout? | |||||
Yes | 135/183 | ref. | ref. | ||
No | 571/1105 | 0.380 (0.268, 0.539) | < 0.001 | 0.689 (0.436, 1.089) | 0.111 |
Cut-off value: ≥27.5/<27.5 | n | Univariable | Multivariable (regression method: enter) | ||
---|---|---|---|---|---|
OR (95%CI) | P | OR (95%CI) | P | ||
Gender | |||||
Male | 273/559 | ref. | |||
Female | 373/729 | 1.098 (0.880, 1.368) | 0.407 | ||
Age | |||||
≤ 25years | 110/283 | ref. | |||
26–30 years | 151/296 | 1.638 (1.177, 2.279) | 0.003 | ||
31–35 years | 135/249 | 1.455 (1.079, 1.963) | 0.014 | ||
36–40 years | 147/296 | 1.070 (0.820, 1.396) | 0.619 | ||
41–44 years | 103/164 | 1.800 (1.284, 2.524) | 0.001 | ||
Education level | |||||
High school or below | 30/84 | ref. | ref. | ||
Bachelor/associate | 371/731 | 1.855 (1.160, 2.966) | 0.010 | 1.470 (0.895, 2.414) | 0.128 |
Postgraduate or above | 245/473 | 1.420 (1.056, 1.909) | 0.020 | 1.173 (0.851, 1.617) | 0.331 |
Occupation | |||||
Student | 225/349 | ref. | ref. | ||
White-collar/employee | 215/476 | 0.454 (0.342, 0.603) | < 0.001 | 0.386 (0.285, 0.521) | < 0.001 |
Educator | 40/75 | 0.630 (0.381, 1.042) | 0.072 | 0.534 (0.317, 0.899) | 0.018 |
Healthcare worker | 77/203 | 0.337 (0.235, 0.482) | < 0.001 | 0.341 (0.236, 0.493) | < 0.001 |
Other | 89/185 | 0.511 (0.356, 0.734) | < 0.001 | 0.427 (0.289, 0.631) | < 0.001 |
Are you the only child? | |||||
Yes | 331/600 | ref. | ref. | ||
No | 315/688 | 0.686 (0.551, 0.855) | 0.001 | 0.725 (0.573, 0.917) | 0.007 |
Weight status | |||||
Underweight | 53/145 | ref. | |||
Normal weight | 321/601 | 1.990 (1.369, 2.893) | < 0.001 | ||
Overweight | 190/380 | 1.231 (0.935, 1.619) | 0.139 | ||
Obese | 82/162 | 1.177 (0.839, 1.652) | 0.346 | ||
Do you suffer from hyperuricemia? | |||||
Yes | 174/253 | ref. | ref. | ||
No | 472/1035 | 0.381 (0.284, 0.510) | < 0.001 | 0.442 (0.296, 0.659) | < 0.001 |
Do you suffer from gout? | |||||
Yes | 121/183 | ref. | ref. | ||
No | 525/1105 | 0.464 (0.334, 0.644) | < 0.001 | 0.719 (0.455, 1.135) | 0.156 |