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Role of diet in hyperuricemia and gout

https://doi.org/10.1016/j.berh.2021.101723Get rights and content

Abstract

Background

Gout is the most common form of inflammatory arthritis, affecting 41 million adults worldwide. The global burden of gout has been increasing over the last three decades, yet its management remains suboptimal. The primary aim of this manuscript is to review the impact of various diets such as the DASH, Mediterranean, and low purine diets; weight loss; and individual foods, including alcohol, caffeine, cherry, dairy, high-fructose corn syrup, omega-3 fatty acids, and vitamin C on hyperuricemia and clinical gout outcomes such as flares and tophi.

Conclusion

Few studies to date have specifically evaluated the effect of various dietary approaches on hyperuricemia among people with gout and on gout-specific outcomes. Overall, the dietary factors appear to have a small effect on serum urate levels, and their impact on the long-term clinical course of gout is uncertain. Limited evidence suggests that avoidance of certain foods and beverages may decrease the frequency of gout flares. Weight loss may be beneficial for prevention as well as treatment of gout. Urate-lowering therapy remains the mainstay of therapy, with diet and dietary factors studied to date playing a limited role in the definitive management of gout.

Section snippets

Introduction and background

According to the latest Global Burden of Disease (GBD) estimates, gout is the most common cause of inflammatory arthritis, affecting 41 million people worldwide [1]. According to the 2015–2016 National Health and Nutrition Examination Survey (NHANES), 3.9% (9.2 million) of US adults have gout [2]. Unfortunately, despite good understanding of the disease pathophysiology and available therapies, the burden of gout remains high and gout management remains suboptimal [3]. The burden of gout is

Production and excretion of urate

Adenine and guanine are purine nucleotide bases that are essential for the formation of DNA and RNA in the form of nucleosides (adenosine, guanosine). As triphosphates (e.g., ATP), they help in cellular energy transfer and utilization. They are also components of co-enzymes and play a significant role in neurotransmission [8]. Thus, purines are critical for normal human physiologic functioning. The link between purines and gout stems from the fact that purine breakdown leads to production of

Dietary factors, hyperuricemia, and gout

Beyond medications, there is much interest in whether dietary approaches can be leveraged as an adjunct to optimize gout management and/or as an option for patients who do not yet meet indications for urate-lowering therapy. The degree to which diet impacts gout management remains controversial. Underexcretion of urate is a major contributor to hyperuricemia in gout, and the majority of urate production is related to metabolism of endogenous purines rather than from exogenous dietary sources [13

Relative contributions to hyperuricemia by genetics and diet

Several studies have evaluated both genetic and dietary contributions to hyperuricemia. In a meta-analysis of 6 cohort studies that included 16,760 patients, the variance in serum urate in the general population was better explained by genetic contributions compared to urate-modifying dietary factors, namely beer, liquor, wine, soft drinks, skimmed milk, and meat [14]. Each of these foods contributed ∼1% of the variation in serum urate, while genetic polymorphisms were estimated to contribute

Role of specific diets in hyperuricemia and gout

The three main diets that have been evaluated in relation to hyperuricemia and gout are DASH, Mediterranean, and low purine diets.

Role of weight loss

Obesity is highly prevalent worldwide, with 1.9 billion adults reported to be overweight or obese [34]. Greater BMI is associated with increased risk of hyperuricemia and gout in a variety of studies [17]. In the Normative Aging Study, an increase in weight was associated with an increase in serum urate over time, though they also noted a general rise in serum urate over time even in people without weight gain; nonetheless, weight gain was the strongest factor associated with rise in serum

Role of individual foods

Over the last several decades, various food items have been studied for their effects on hyperuricemia primarily, with limited studies regarding impact on gout outcomes. Here, we review alcohol, caffeine, cherry, dairy, high-fructose corn syrup, omega-3 fatty acids, and vitamin C.

Conclusion

The available evidence regarding impact of diet on hyperuricemia and gout is largely limited to studies among people without gout. Various dietary approaches may have a small effect of serum urate levels, though for most patients with gout, these effects will be insufficient for adequate gout management and therefore can be considered only as adjunctive measures with pharmacologic therapy needing to be the mainstay of management to achieve the degree of urate-lowering needed to control gout

Author contributions

All authors have contributed to the following: (1) the conception and design of the article, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval.

Funding sources

Dr. Neogi's work was supported by K24 AR070892 and P30 AR072571.

Declaration of competing interest

The authors have no conflicts of interest to disclose.

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    Both authors have contributed equally to the manuscript.

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