Gout and Diet: A Comprehensive Review of Mechanisms and Management

Abstract

Gout is well known as an inflammatory rheumatic disease presenting with arthritis and abnormal metabolism of uric acid. The recognition of diet-induced systemic metabolic pathways have provided new mechanistic insights and potential interventions on gout progression. However, the dietary recommendations for gouty patients generally focus on food categories, with few simultaneous considerations of nutritional factors and systemic metabolism. It is worthwhile to comprehensively review the mechanistic findings and potential interventions of diet-related nutrients against the development of gout, including purine metabolism, urate deposition, and gouty inflammation. Although piecemeal modifications of various nutrients often provide incomplete dietary recommendations, understanding the role of nutritional factors in gouty development can help patients choose their healthy diet based on personal preference and disease course. The combination of dietary management and medication may potentially achieve enhanced treatment effects, especially for severe patients. Therefore, the role of dietary and nutritional factors in the development of gout is systematically reviewed to propose dietary modification strategies for gout management by: (1) reducing nutritional risk factors against metabolic syndrome; (2) supplementing with beneficial nutrients to affect uric acid metabolism and gouty inflammation; and (3) considering nutritional modification combined with medication supplementation to decrease the frequency of gout flares.

Global, regional and national temporal trends in prevalence for musculoskeletal disorders in women of childbearing age, 1990–2019: an age-period-cohort analysis based on the Global Burden of Disease Study 2019

“…On the one hand, the initiation and exacerbation of MSK disorders are closely associated with harmful environmental exposure such as industrial air pollution emissions,8 26 27 which always exist in higher SDI regions for that these regions usually have accomplished or are experiencing industrialisation and urbanisation. On the other hand, individuals in higher SDI regions are more likely to get into nutrition overload including high fat, high sugar, high protein, etc , which are recognised to be vital risk factors for several MSK disorders such as gout 28. In addition, older age groups especially 45–49 years accounted for the major increase of MSK disorders prevalence in WCBA except in high SDI region, where the younger age groups appeared to be more prominent.…”

Endurance-dependent urinary extracellular vesicle signature: shape, metabolic miRNAs, and purine content distinguish triathletes from inactive people

“…Considering that several factors can affect real purine content, such as region and seasonal food production, food processing (e.g., dehydration), cooking, and storage [ 20 , 52 ], we cannot accurately quantify purine intake in our groups and then differentiate dietary from endogenous contribution to the body purine pool. However, we know diet is an exogenous source of nucleotides mostly as nucleosides adenosine monophosphate (AMP) and guanine monophosphate (GMP) [ 54 ]. Dietary purines are absorbed through the small intestine and, following the purine metabolic pathway, their metabolites are degraded and excreted as uric acid, the latter’s serum and urine concentration mostly affected by adenine and hypoxanthine [ 20 , 52 ].…”

Nutritional factors in the prevention and treatment of gout

“…In consequence, in 2020 the American College of Rheumatology's (ACR) Gout Guideline made a conditional recommendation against use of vitamin C in people with gout [41]. Just like vitamin C, vitamin A and vitamin E also show beneficial effects against oxidative stress and inflammation, as well as effectively decreasing serum uric acid (SUA) levels [42]. The cross-sectional study evaluated the association of dietary vitamin E intake with hyperuricemia in US adults.…”

“…The effect could be sustained thanks to adjusting for known risk factors for gout flares and anti-gout medications [63]. However, due to insufficient data, the 2020 ACR guideline for the management of gout does not make a specific recommendation regarding cherries/cherry juice concentrate intake [42].…”