Dietary Interventions for Gout and Effect on Cardiovascular Risk Factors: A Systematic Review

Abstract

Gout is one of the most prevalent inflammatory rheumatic disease. It is preceded by hyperuricemia and associated with an increased risk for cardiovascular disease, both related to unhealthy diets. The objective of this systematic review is to better define the most appropriate diet addressing both disease activity and traditional cardiovascular risk factors in hyperuricemic patients. We included clinical trials with patients diagnosed with hyperuricemia or gout, investigating the effect of dietary interventions on serum uric acid (SUA) levels, gout flares and—if available—cardiovascular risk factors. Eighteen articles were included, which were too heterogeneous to perform a meta-analysis. Overall, the risk of bias of the studies was moderate to high. We distinguished four groups of dietary interventions: Calorie restriction and fasting, purine-low diets, Mediterranean-style diets, and supplements. Overall, fasting resulted in an increase of SUA, whilst small (SUA change +0.3 to −2.9 mg/dL) but significant effects were found after low-calorie, purine-low, and Mediterranean-style diets. Studies investigating the effect on cardiovascular risk factors were limited and inconclusive. Since Mediterranean-style diets/DASH (Dietary Approach to Stop Hypertension) have shown to be effective for the reduction of cardiovascular risk factors in other at-risk populations, we recommend further investigation of such diets for the treatment of gout.

Therapeutic Strategies for the Treatment of Chronic Hyperuricemia: An Evidence-Based Update

“…Today there is no clear evidence that lifestyle modification might be effective in decreasing SUA levels: insofar as a low-energy Mediterranean diet aimed at achieving optimal body weight seems reasonably the best approach [ 113 ]. Single nutrients and food have been associated with impaired or improved SUA levels, but definite data are yet lacking.…”

Cell lineage-specific methylome and genome alterations in gout

“…For example, previous studies found that the risk of gout was inversely associated with consumption of coffee and omega-3 fatty acids, both of which decreased DNA methylation [ 58 – 61 ]. Conversely, legumes, which increased methylation, reduced the risk of gout [ 62 , 63 ]. Additional studies are needed to identify other environmental factors that might impact gout by increasing or decreasing DNA methylation.…”

Faculty Service-Learning Students as Home-Visitors: Outcomes of a Lifestyle Modification Program for Vulnerable Families With Residents in Rural Indonesian Communities

“…Furthermore, the protocol of stretching exercises was developed based on recommendations from the Guidelines for Exercise Testing and Prescription proposed by the American College of Sports Medicine (39). When encountering medical related scenarios with self-reported hyperthyroidism, hyperuricemia, or urinary stones, the servicelearning students consulted supervisors, who were experienced registered nurses, regarding foods not to recommend and/or increase in amount, such as iodine-rich foods (40,41), purinerich foods (42,43), and diets high in salt, purine, and oxalate (44,45), respectively. In addition, pork was not to be suggested for Muslims due to religious reasons.…”