A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout

Abstract

The Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate (SU); however, the impact of the DASH diet has not been previously evaluated among patients with gout. We conducted a randomized, controlled, crossover pilot study to test the effects of ~$105/week ($15/day) of dietitian-directed groceries (DDG), patterned after the DASH diet, on SU, compared with self-directed grocery shopping (SDG). Participants had gout and were not taking urate lowering therapy. Each intervention period lasted 4 weeks; crossover occurred without a washout period. The primary endpoint was SU. Compliance was assessed by end-of-period fasting spot urine potassium and sodium measurements and self-reported consumption of daily servings of fruit and vegetables. We randomized 43 participants (19% women, 49% black, mean age 59 years) with 100% follow-up. Mean baseline SU was 8.1 mg/dL (SD, 0.8). During Period 1, DDG lowered SU by 0.55 mg/dL (95% CI: 0.07, 1.04) compared to SDG by 0.0 mg/dL (95% CI: −0.44, 0.44). However, after crossover (Period 2), the SU difference between groups was the opposite: SDG reduced SU by −0.48 mg/dL (95% CI: −0.98, 0.01) compared to DDG by −0.05 mg/dL (95% CI: −0.48, 0.38; P for interaction by period = 0.11). Nevertheless, DDG improved self-reported intake of fruit and vegetables (3.1 servings/day; 95% CI: 1.5, 4.8) and significantly reduced total spot urine sodium excretion by 22 percentage points (95% CI: −34.0, −8.6). Though relatively small in scale, this pilot study suggests that dietitian-directed, DASH-patterned groceries may lower SU among gout patients not on urate-lowering drugs. However, behavior intervention crossover trials without a washout period are likely vulnerable to strong carryover effects. Definitive evaluation of the DASH diet as a treatment for gout will require a controlled feeding trial, ideally with a parallel-design.

Nutritional factors in the prevention and treatment of gout

“…There is also a strong emphasis on limiting the consumption of sodium, sugar and saturated fats [24].This dietary pattern among many health benefits is associated not only with the lower risk of gout as prospective cohort study conducted on men investigated [25], but its benefits were also observed among patients who already have gout and were at a time not during pharmacological urate lowering therapy (ULT). The outcome suggested that this strategy may be a useful tool to lower the urate serum level [26].This evidence is also supported by another study which compared a dash diet to standard diet and one with higher vegetables and fruits consumption, but without other restriction. Dash diet turned out to be the most beneficial in reducing serum urate levels [27].…”

Quality Characteristics and Inhibitory Xanthine Oxidase Potential of 21 Sour Cherry (Prunus Cerasus L.) Varieties Cultivated in China

“…Cherries were considered to be a good source of dietary K, which played an important role in the Dietary Approaches to Stop Hypertension (DASH), and could reduce blood pressure and stroke risk ( 1 ), as well as lowering serum urate among gout patients ( 36 ). In the accessions, the contents of K ranged from 250.906 to 453.887 mg/100 g FW, much higher than the records in the USDA MyPyramid nutrient data 173 and 222 mg/100 g FW at sour and sweet cherries respectively ( 1 ).…”

“…Furthermore, these cultivars showed lower values of chrome (C) and hue angle (H), corresponding to a darker and more intense color. The differences among sour cherry cultivars in fruit color may also underline the variability in the accumulation pattern of specific anthocyanin molecules ( 14), the larger the number of hydroxyl groups on the B-ring, the bluer the color (35). And as pH increase, the color of anthocyanin moves to the non-spectral purple and approaches a progressive loss of fruit color.…”

Expanding the role of Australian community dietitians in gout management

“…Recent pilot studies suggest that dietitian-directed diet modification may lower SUA concentrations and gout flares in people with gout. 24,25 However, previous studies, not involving dietitians, have demonstrated that providing general dietary education compared with specific dietary recommendations for gout to people already on ULT does not affect SUA concentrations. 26 Such uncertainty surrounding diet interventions could, in part, also account for the reported lack of referrals from GPs to dietitians specifically for gout.…”