Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study

Abstract

Objectives-Insulin resistance (IR) has been increasingly implicated in the pathogenesis of gout. The lipoprotein abnormalities described in hyperuricaemic subjects are similar to those associated with IR, and insulin influences renal urate excretion. In this study it was investigated whether dietary measures, reported to be beneficial in IR, have serum uric acid (SU) and lipid lowering eVects in gout. Methods-Thirteen non-diabetic men (median age 50, range 38-62) were enrolled. Each patient had had at least two gouty attacks during the four months before enrolment. Dietary recommendations consisted of calorie restriction to 6690 kJ (1600 kcal) a day with 40% derived from carbohydrate, 30% from protein, and 30% from fat; replacement of refined carbohydrates with complex ones and saturated fats with mono-and polyunsaturated ones. At onset and after 16 weeks, fasting blood samples were taken for determination of SU, serum cholesterol (C), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides (TGs). Results were expressed as median (SD). Results-At

Prevalence of the metabolic syndrome in patients with gout: The Third National Health and Nutrition Examination Survey

“…For example, conventional dietary recommendations for gout have focused on restriction of purine intake, although low-purine diets are often high in carbohydrate and saturated fat (7). These macronutrients are associated with an increased risk of insulin resistance syndrome and associated major consequences (21,32,33). Furthermore, these macronutrients tend to lead to higher serum insulin levels, which are known to reduce renal excretion of urate (11,19 -21), thus potentially raising the serum uric acid level and the risk of gout.…”

Dietary manipulation in musculoskeletal conditions

“…A rapid reduction in weight is not advisable as this may trigger an attack of acute gout. Raised serum uric acid is associated with several conditions known collectively as the "metabolic syndrome" namely hyperlipidaemia, hypertension, obesity and insulin resistance [26] [27]. These co-morbidities should be addressed by dietary and lifestyle modification where possible.…”

Uric acid levels in metabolically healthy and unhealthy obese patients

“…Serum ÜA ile obezite, dislipidemi, hipertansiyon, bozulmuş glukoz metabolizması gibi KVH risk parametrelerinin ilişkisini açıklamak için birçok sebep ileri sürülmüştür. Artmış insülin seviyeleri ve insülin direnci, artmış leptin seviyeleri, obeziteye de yol açan artmış fruktoz tüketiminin ÜA'in renal klerensini azalttığı ya da renal tübüler reabsorbsiyonunu arttır-dığı ileri sürülen faktörlerdendir [15][16][17][18][19][20][21][22]. Ek olarak; hipertrigliserideminin kendisinin de ÜA'in renal atı-lımını azalttığını, TG seviyelerinde azalmanın idrar ÜA seviyelerini arttırdığını ortaya koyan çalışmalar da vardır [23][24][25].…”