Diet in gout – should we reduce the intake of purines?
Authors:
L. Hasíková; J. Závada
Authors place of work:
Revmatologický ústav a Revmatologická klinika 1. LF UK, Praha
Published in the journal:
Čes. Revmatol., 28, 2020, No. 3, p. 182-191.
Category:
Review Article
Summary
Gout is inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and soft tissues. In addition to classic manifestations, gout and hyperuricemia are associated with a number of metabolic and cardiovascular diseases. Consumption of certain foods and beverages has always been associated with the development of gout. Data from large observational studies have identified some components of the diet that increase serum uric acid levels. These include mainly beverages and foods high in fructose, beer, spirits, red meat, and seafood. On the contrary, low-fat dairy products seem to be protective. However, data from randomized controlled trials demonstrating a clear relationship between food components and gout are lacking. It turns out that the overall effect of diet has only a small impact on serum uric acid at the population level in individuals without gout. However, according to the recommendations of international rheumatological societies, a comprehensive therapeutic approach to the gout patient should also aim to adjust eating habits and lifestyle, as an attempt to reduce serum uric acid levels, frequency of gout attacks and also to prevent overall cardiovascular risk.
Keywords:
alcohol – Diet – gout – hyperuricemia – Purines – fructose
Zdroje
1. Roddy E, Choi HK. Epidemiology of gout. Rheum Dis Clin North Am 2014; 40(2): 155–175.
2. Hayden MR, Tyagi SC. Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: The urate redox shuttle. Nutr Metab (London) 2004; 1(1): 10.
3. Ebrahimpour P, Fakhrzadeh H, Heshmat R, et al. Serum uric acid levels and risk of metabolic syndrome in healthy adults. Endocr Pract 2008; 14(3): 298–304.
4. Heinig M, Johnson RJ. Role of uric acid in hypertension, renal disease, and metabolic syndrome. Cleve Clin J Med 2006; 73(12): 1059–1064.
5. Andres M, Bernal JA, Sivera F, et al. Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment. Ann Rheum Dis 2017; 76(7): 1263–1268.
6. Holland R, McGill NW. Comprehensive dietary education in treated gout patients does not further improve serum urate. Intern Med J 2015; 45(2): 189–194.
7. Moi JH, Sriranganathan MK, Falzon L, et al. Lifestyle interventions for the treatment of gout: a summary of 2 Cochrane systematic reviews. J Rheumatol Suppl 2014; 92: 26–32.
8. Major TJ, Topless RK, Dalbeth N, et al. Evaluation of the diet wide contribution to serum urate levels: meta–analysis of population based cohorts. BMJ 2018; 363: k3951.
9. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017; 76(1): 29–42.
10. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 2012; 64(10): 1431–1446.
11. Choi HK, McCormick N, Lu N, et al. Population Impact Attributable to Modifiable Risk Factors for Hyperuricemia. Arthritis Rheumatol 2020; 72(1): 157–165.
12. Nielsen SM, Bartels EM, Henriksen M, et al. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis 2017; 76(11): 1870–1882.
13. Choi HK, Atkinson K, Karlson EW, et al. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med 2005; 165(7): 742–748.
14. Zhu Y, Zhang Y, Choi HK. The serum urate-lowering impact of weight loss among men with a high cardiovascular risk profile: the Multiple Risk Factor Intervention Trial. Rheumatology (Oxford) 2010; 49(12): 2391–2399.
15. Maglio C, Peltonen M, Neovius M, et al. Effects of bariatric surgery on gout incidence in the Swedish Obese Subjects study: a non-randomised, prospective, controlled intervention trial. Ann Rheum Dis 2017; 76(4): 688–693.
16. Dalbeth N, Chen P, White M, et al. Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study. Ann Rheum Dis 2014; 73(5): 797–802.
17. Romero-Talamas H, Daigle CR, Aminian A, et al. The effect of bariatric surgery on gout: a comparative study. Surg Obes Relat Dis 2014; 10(6): 1161–1165.
18. Williams PT. Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men. The American Journal of Clinical Nutrition 2008; 87(5): 1480–1487.
19. Emmerson BT. The management of gout. N Engl J Med 1996; 334(7): 445–451.
20. Yu T, Yu TF. Milestones in the treatment of gout. Am J Med 1974; 56(5): 676–685.
21. Clifford AJ, Riumallo JA, Young VR, et al. Effect of oral purines on serum and urinary uric acid of normal, hyperuricemic and gouty humans. The Journal of Nutrition 1976; 106(3): 428–434.
22. Havlik J, Plachy V, Fernandez J, et al. Dietary purines in vegetarian meat analogues. J Sci Food Agric 2010; 90(14): 2352–2357.
23. Kaneko K, Aoyagi Y, Fukuuchi T, et al. Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biol Pharm Bull 2014; 37(5): 709–721.
24. Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2005; 52(1): 283–289.
25. Choi HK, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004; 350(11): 1093–1103.
26. Zhang Y, Chen C, Choi H, et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis 2012; 71(9): 1448–1453.
27. Torralba KD, De Jesus E, Rachabattula S. The interplay between diet, urate transporters and the risk for gout and hyperuricemia: current and future directions. Int J Rheum Dis 2012; 15(6): 499–506.
28. Schmidt JA, Crowe FL, Appleby PN, et al. Serum uric acid concentrations in meat eaters, fish eaters, vegetarians and vegans: a cross-sectional analysis in the EPIC-Oxford cohort. PLoS One 2013; 8(2): e56339.
29. Zhang M, Zhang Y, Terkeltaub R, et al. Effect of dietary and supplemental omega-3 polyunsaturated fatty acids on risk of recurrent gout flares. Arthritis Rheumatol 2019; 71(9): 1580–1586.
30. Choi HK, Curhan G. Beer, liquor, and wine consumption and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2004; 51(6): 1023–1029.
31. Choi HK, Atkinson K, Karlson EW, et al. Alcohol intake and risk of incident gout in men: a prospective study. Lancet 2004; 363(9417): 1277–1281.
32. Neogi T, Chen C, Niu J, et al. Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. Am J Med 2014; 127(4): 311–318.
33. Johnson RJ, Perez-Pozo SE, Sautin YY, et al. Hypothesis: could excessive fructose intake and uric acid cause type 2 diabetes? Endocr Rev 2009; 30(1): 96–116.
34. Faller J, Fox IH. Ethanol-induced hyperuricemia: evidence for increased urate production by activation of adenine nucleotide turnover. N Engl J Med 1982; 307(26): 1598–1602.
35. Lieber CS, Jones DP, Losowsky MS, et al. Interrelation of uric acid and ethanol metabolism in man. J Clin Invest 1962; 41: 1863–1870.
36. Gibson T, Rodgers AV, Simmonds HA, et al. Beer drinking and its effect on uric acid. Br J Rheumatol 1984; 23(3): 203–209.
37. Yamamoto T, Moriwaki Y, Takahashi S, et al. Effect of beer on the plasma concentrations of uridine and purine bases. Metabolism 2002; 51(10): 1317–1323.
38. Choi JW, Ford ES, Gao X, et al. Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2008; 59(1): 109–116.
39. Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA 2010; 304(20): 2270–2278.
40. Dalbeth N, Phipps-Green A, House ME, et al. Body mass index modulates the relationship of sugar–sweetened beverage intake with serum urate concentrations and gout. Arthritis Res Ther 2015; 17: 263.
41. Batt C, Phipps-Green AJ, Black MA, et al. Sugar-sweetened beverage consumption: a risk factor for prevalent gout with SLC2A9 genotype-specific effects on serum urate and risk of gout. Ann Rheum Dis 2014; 73(12): 2101–2106.
42. Raivio KO, Becker A, Meyer LJ, et al. Stimulation of human purine synthesis de novo by fructose infusion. Metabolism 1975; 24(7): 861–869.
43. Zgaga L, Theodoratou E, Kyle J, et al. The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study. PLoS One 2012; 7(6): e38123.
44. Ryu KA, Kang HH, Kim SY, et al. Comparison of nutrient intake and diet quality between hyperuricemia subjects and controls in Korea. Clin Nutr Res 2014; 3(1): 56–63.
45. Dalbeth N, Gracey E, Pool B, et al. Identification of dairy fractions with anti-nflammatory properties in models of acute gout. Ann Rheum Dis 2010; 69(4): 766–769.
46. Dalbeth N, Ames R, Gamble GD, et al. Effects of skim milk powder enriched with glycomacropeptide and G600 milk fat extract on frequency of gout flares: a proof-of-concept randomised controlled trial. Ann Rheum Dis 2012; 71(6): 929–934.
47. Kiyohara C, Kono S, Honjo S, et al. Inverse association between coffee drinking and serum uric acid concentrations in middle-aged Japanese males. Br J Nutr 1999; 82(2): 125–130.
48. Choi HK, Willett W, Curhan G. Coffee consumption and risk of incident gout in men: a prospective study. Arthritis Rheum 2007; 56(6): 2049–2055.
49. Pham NM, Yoshida D, Morita M, et al. The relation of coffee consumption to serum uric Acid in Japanese men and women aged 49–76 years. J Nutr Metab 2010; 2010.
50. Choi HK, Curhan G. Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey. Arthritis Rheum 2007; 57(5): 816–821.
51. Choi HK, Curhan G. Coffee consumption and risk of incident gout in women: the Nurses’ Health Study. Am J Clin Nutr 2010; 92(4): 922–927.
52. Huang HY, Appel LJ, Choi MJ, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum 2005; 52(6): 1843–1847.
53. Juraschek SP, Miller ER, 3rd, Gelber AC. Effect of oral vitamin C supplementation on serum uric acid: a meta-analysis of randomized controlled trials. Arthritis Care Res (Hoboken) 2011; 63(9): 1295–1306.
54. Choi HK, Gao X, Curhan G. Vitamin C intake and the risk of gout in men: a prospective study. Arch Intern Med 2009; 169(5): 502–507.
55. Stamp LK, O’Donnell JL, Frampton C, et al. Clinically insignificant effect of supplemental vitamin C on serum urate in patients with gout: a pilot randomized controlled trial. Arthritis Rheum 2013; 65(6): 1636–1642.
56. Jacob RA, Spinozzi GM, Simon VA, et al. Consumption of cherries lowers plasma urate in healthy women. J Nutr 2003; 133(6): 1826–1829.
57. Zhang Y, Neogi T, Chen C, et al. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis Rheum 2012; 64(12): 4004–4011.
58. Stamp LK, Chapman P, Frampton C, et al. Lack of effect of tart cherry concentrate dose on serum urate in people with gout. [published online ahead of print, 2019 Dec 31]. Rheumatology (Oxford) 2019; kez606. doi:10.1093/rheumatology/kez606
59. Lyu LC, Hsu CY, Yeh CY, et al. A case-control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr 2003; 78(4): 690–701.
60. Joosten LA, Netea MG, Mylona E, et al. Engagement of fatty acids with Toll-like receptor 2 drives interleukin-1beta production via the ASC/caspase 1 pathway in monosodium urate monohydrate crystal-induced gouty arthritis. Arthritis Rheum 2010; 62(11): 3237–3248.
61. Flynn TJ, Cadzow M, Dalbeth N, et al. Positive association of tomato consumption with serum urate: support for tomato consumption as an anecdotal trigger of gout flares. BMC Musculoskelet Disord 2015; 16: 196.
62. Johnson RJ, Nakagawa T, Sanchez-Lozada LG, et al. Umami: the taste that drives purine intake. J Rheumatol 2013; 40(11): 1794–1796.
63. Bahn A, Hagos Y, Reuter S, et al. Identification of a new urate and high affinity nicotinate transporter, hOAT10 (SLC22A13). J Biol Chem 2008; 283(24): 16332–16341.
64. Enomoto A, Kimura H, Chairoungdua A, et al. Molecular identification of a renal urate anion exchanger that regulates blood urate levels. Nature 2002; 417(6887): 447–452.
65. Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout. Curr Opin Rheumatol 2010; 22(2): 165–172.
66. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344(1): 3–10.
67. Juraschek SP, Gelber AC, Choi HK, et al. Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet and Sodium Intake on Serum Uric Acid. Arthritis Rheumatol 2016; 68(12): 3002–3009.
68. Rai SK, Fung TT, Lu N, et al. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ 2017; 357: j1794.
69. Kontogianni MD, Chrysohoou C, Panagiotakos DB, et al. Adherence to the Mediterranean diet and serum uric acid: the ATTICA study. Scand J Rheumatol 2012; 41(6): 442–449.
70. Yokose C RS, Lu N, McCormick N, Curhan G, Choi H. . The effects of a low-fat, mediterranean, or low-carbohydrate diet on serum urate [Abstract]. Arthritis Rheumatol 2019; 71(Suppl 10).
71. Lockyer S, Stanner S. Diet and gout – what is the role of purines? Nutrition Bulletin 2016; 41(2): 155–166.
72. Beyl RN, Jr., Hughes L, Morgan S. Update on Importance of Diet in Gout. Am J Med 2016; 129(11): 1153–1158.
Štítky
Dermatology & STDs Paediatric rheumatology RheumatologyČlánok vyšiel v časopise
Czech Rheumatology
2020 Číslo 3
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