BACKGROUND: The purpose of this study was to evaluate the impact of adherence to Mediterranean diet on serum uric acid (UA) levels in elderly individuals, without known cardiovascular disease. METHODS: During 2009, 281 females (75±6 years old) and 257 males (75±7 years old) permanent inhabitants of the island, were voluntarily enrolled. A diet score that assesses the inherent characteristics of the Mediterranean diet (MedDietScore, range 0-55) was applied. Serum levels of UA were determined using an enzymatic colorimetric test through the uricase-peroxidase method. Hyperuricaemia was defined as UA>7 mg/dL in males and 6 mg/dL in females. RESULTS: Prevalence of hyperuricaemia was 34% in males and 25% in females (p=0.02). Mean level of adherence to the Mediterranean diet was 35±2. Linear regression analysis revealed that MedDietScore was inversely associated with UA levels (b±SE: -1.48±0.17, p<0.001) in the overall sample, after controlling for hypertension, hypercholesterolemia, diabetes mellitus, creatinine clearance, physical activity, and coffee consumption. When the analysis was stratified by gender, MedDietScore was inversely associated with UA levels in males (b±SE: -1.10±0.42, p=0.009), but not in females (b±SE: 0.04±0.41, p=0.92). CONCLUSION: Another cardioprotective effect of Mediterranean diet was revealed, through the modification of UA levels in elderly individuals. The potential different effect size as regards the relationship between diet and UA levels between genders, deserves further investigation.