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*Read only for medical professionals Reference High uric acid? Dietary abstinence is key! Gout is a metabolic disease, and uric acid is the end product of human purine metabolism.
The normal human blood uric acid concentration is about 5-6 mg/dl
.
Persistent hyperuricemia forms crystals and deposits in the body, causing acute characteristic arthritis and chronic tophi, which can be complicated by kidney disease; severe cases may lead to joint destruction, impaired renal function, and often accompanied by central obesity and hyperlipidemia diabetes, type 2 diabetes, metabolic syndrome,
etc.
At the annual meeting of the Rheumatology and Immunology Branch of the Chinese Medical Doctor Association in 2021, Professor Dai Lie of Sun Yat-sen Memorial Hospital of Sun Yat-sen University brought you a special report on "Progress in the Non-drug Treatment of Gout", let us review the exciting content together
.
The current situation of gout is worrying, and the epidemiology of acute exacerbation is more predisposing to gout.
The increasingly popular western life>
.
Epidemiological data on gout show an upward trend in global prevalence; obesity and comorbidities are important drivers; close coexistence with metabolic syndrome; and increased mortality, which remains unabated
.
The triggers of acute gout attacks include: alcohol consumption; high purine diet; trauma; excessive fatigue; cold; drugs: thiazide diuretics, cyclosporine A, etc.
; surgery (3 to 5 days after surgery)
;
The effect of diet on gout 01 Purines in diet and purines in gout foods increase the load of blood uric acid, leading to the formation of urate crystals and promoting gout attacks, such as animal offal, seafood, and beer are high purine foods
.
But different sources of purines have different effects on gout: foods with higher animal purines are risk factors for gout; foods with higher plant purines (such as certain vegetables) do not increase blood uric acid
.
In addition, some foods with low purine content may also increase the risk of gout, such as fructose-rich fruits and beverages
.
02Limitations of low-purine diet Ideally, gout patients should adhere to a low-purine diet, but a low-purine diet is not a big deal
.
A strict low-purine diet has limited uric acid-lowering effect, but it cannot reduce blood uric acid to less than 6 mg/dl; the practical operation is less feasible, patients are difficult to strictly follow, and the compliance is poor; low-purine diet will lead to insufficient protein intake, which cannot be satisfied The body's daily nutritional needs; a low-purine diet increases carbohydrate and fat intake, leading to insulin resistance, which in turn causes metabolic syndrome, which increases serum uric acid and cardiovascular risk
.
03 The contradiction of gout diet control Generally speaking, long-term intake of purine-rich foods is not recommended clinically; although some purine-rich foods (such as fish rich in omega-3 fatty acids, red wine) short-term intake can lead to Gout attacks, but moderate intake can bring cardiometabolic benefits to gout patients
.
Temporary restriction of intake of fish (seafood) rich in omega-3 fatty acids: recurrent gout attacks or the initial stage of uric acid lowering therapy (ULT); resume intake: preventive measures for gout attacks have been taken or drugs have been adequately reduced blood uric acid
.
Red wine: moderate intake of red wine in the short term will increase the risk of gout attacks, but red wine is not a high risk factor for gout and hyperuricemia.
Some studies suggest that red wine intake may bring cardiometabolic benefits
.
Risk factors for gout.
Dietary risk factors: red meat, seafood, fructose, sugar-sweetened beverages, alcohol
.
Protective factors: low-fat yogurt, coffee, vitamin C, DASH diet, vegan diet
.
A meta-analysis of 16,760 people with genetic inclusion showed that diet could explain 0.
3% of serum uric acid variability, while genetic polymorphism could explain 23.
9%
.
However, the extent to which genes and diet influence serum uric acid remains controversial
.
In the overall population, overweight or obesity had a greater impact on serum uric acid variability (44%) than any one dietary factor
.
Inappropriate diet recommended by the healthy dietary pattern has adverse effects on the incidence and disease of gout, and is even related to death; on the contrary, the improvement of diet quality can reduce the mortality of gout
.
The latest concept advocates that everyone pay attention to dietary patterns, and the relationship between diet and health is shifted from a single nutrient or single food to research on the association between dietary patterns and overall health status or disease risk; a balanced dietary pattern is based on nutritional science principles and residents' dietary nutrient reference intakes and designed
.
Long-term adherence to a balanced dietary pattern is an important cornerstone for healthy longevity and prevention of diet-related chronic diseases, and can reduce the risk of all-cause mortality
.
In 2021, China's healthy diet model recommended Jiangnan region model represents the oriental healthy diet model: more vegetables and fruits; more fish and shrimp aquatic products; frequent milk and soybean products; moderate amount of cereals and meat and poultry; light cooking and less salt
.
Studies have shown that people who adhere to the Jiangnan model have lower risks of diseases such as overweight and obesity, type 2 diabetes, metabolic syndrome, and stroke
.
Dietary Guidelines for U.
S.
Residents: 4 core recommendations to follow healthy dietary patterns at every stage of life; select and enjoy nutrient-dense foods and beverages, taking into account individual dietary preferences, cultural traditions, and cost; special attention should be paid to nutrient-dense foods food and beverages to meet food needs and energy limitations; reduce foods and beverages high in added sugar, saturated fatty acids, and sodium, and limit alcoholic beverages
.
A new concept of dietary therapy for gout patients The primary purpose of dietary therapy for gout is cardiovascular benefit, rather than reducing serum uric acid
.
Therefore, the status of dietary control needs to be strengthened: any dietary recommendations for hyperuricemia and gout should simultaneously provide cardiometabolic benefits to reduce excessive morbidity and mortality; promote healthy eating patterns; Purine diet; dietary recommendations for Chinese 2021 and US residents (2020-2025); Mediterranean diet and DASH diet; personalized gout diet recommendations
.
Mediterranean diet
The normal human blood uric acid concentration is about 5-6 mg/dl
.
Persistent hyperuricemia forms crystals and deposits in the body, causing acute characteristic arthritis and chronic tophi, which can be complicated by kidney disease; severe cases may lead to joint destruction, impaired renal function, and often accompanied by central obesity and hyperlipidemia diabetes, type 2 diabetes, metabolic syndrome,
etc.
At the annual meeting of the Rheumatology and Immunology Branch of the Chinese Medical Doctor Association in 2021, Professor Dai Lie of Sun Yat-sen Memorial Hospital of Sun Yat-sen University brought you a special report on "Progress in the Non-drug Treatment of Gout", let us review the exciting content together
.
The current situation of gout is worrying, and the epidemiology of acute exacerbation is more predisposing to gout.
The increasingly popular western life>
.
Epidemiological data on gout show an upward trend in global prevalence; obesity and comorbidities are important drivers; close coexistence with metabolic syndrome; and increased mortality, which remains unabated
.
The triggers of acute gout attacks include: alcohol consumption; high purine diet; trauma; excessive fatigue; cold; drugs: thiazide diuretics, cyclosporine A, etc.
; surgery (3 to 5 days after surgery)
;
The effect of diet on gout 01 Purines in diet and purines in gout foods increase the load of blood uric acid, leading to the formation of urate crystals and promoting gout attacks, such as animal offal, seafood, and beer are high purine foods
.
But different sources of purines have different effects on gout: foods with higher animal purines are risk factors for gout; foods with higher plant purines (such as certain vegetables) do not increase blood uric acid
.
In addition, some foods with low purine content may also increase the risk of gout, such as fructose-rich fruits and beverages
.
02Limitations of low-purine diet Ideally, gout patients should adhere to a low-purine diet, but a low-purine diet is not a big deal
.
A strict low-purine diet has limited uric acid-lowering effect, but it cannot reduce blood uric acid to less than 6 mg/dl; the practical operation is less feasible, patients are difficult to strictly follow, and the compliance is poor; low-purine diet will lead to insufficient protein intake, which cannot be satisfied The body's daily nutritional needs; a low-purine diet increases carbohydrate and fat intake, leading to insulin resistance, which in turn causes metabolic syndrome, which increases serum uric acid and cardiovascular risk
.
03 The contradiction of gout diet control Generally speaking, long-term intake of purine-rich foods is not recommended clinically; although some purine-rich foods (such as fish rich in omega-3 fatty acids, red wine) short-term intake can lead to Gout attacks, but moderate intake can bring cardiometabolic benefits to gout patients
.
Temporary restriction of intake of fish (seafood) rich in omega-3 fatty acids: recurrent gout attacks or the initial stage of uric acid lowering therapy (ULT); resume intake: preventive measures for gout attacks have been taken or drugs have been adequately reduced blood uric acid
.
Red wine: moderate intake of red wine in the short term will increase the risk of gout attacks, but red wine is not a high risk factor for gout and hyperuricemia.
Some studies suggest that red wine intake may bring cardiometabolic benefits
.
Risk factors for gout.
Dietary risk factors: red meat, seafood, fructose, sugar-sweetened beverages, alcohol
.
Protective factors: low-fat yogurt, coffee, vitamin C, DASH diet, vegan diet
.
A meta-analysis of 16,760 people with genetic inclusion showed that diet could explain 0.
3% of serum uric acid variability, while genetic polymorphism could explain 23.
9%
.
However, the extent to which genes and diet influence serum uric acid remains controversial
.
In the overall population, overweight or obesity had a greater impact on serum uric acid variability (44%) than any one dietary factor
.
Inappropriate diet recommended by the healthy dietary pattern has adverse effects on the incidence and disease of gout, and is even related to death; on the contrary, the improvement of diet quality can reduce the mortality of gout
.
The latest concept advocates that everyone pay attention to dietary patterns, and the relationship between diet and health is shifted from a single nutrient or single food to research on the association between dietary patterns and overall health status or disease risk; a balanced dietary pattern is based on nutritional science principles and residents' dietary nutrient reference intakes and designed
.
Long-term adherence to a balanced dietary pattern is an important cornerstone for healthy longevity and prevention of diet-related chronic diseases, and can reduce the risk of all-cause mortality
.
In 2021, China's healthy diet model recommended Jiangnan region model represents the oriental healthy diet model: more vegetables and fruits; more fish and shrimp aquatic products; frequent milk and soybean products; moderate amount of cereals and meat and poultry; light cooking and less salt
.
Studies have shown that people who adhere to the Jiangnan model have lower risks of diseases such as overweight and obesity, type 2 diabetes, metabolic syndrome, and stroke
.
Dietary Guidelines for U.
S.
Residents: 4 core recommendations to follow healthy dietary patterns at every stage of life; select and enjoy nutrient-dense foods and beverages, taking into account individual dietary preferences, cultural traditions, and cost; special attention should be paid to nutrient-dense foods food and beverages to meet food needs and energy limitations; reduce foods and beverages high in added sugar, saturated fatty acids, and sodium, and limit alcoholic beverages
.
A new concept of dietary therapy for gout patients The primary purpose of dietary therapy for gout is cardiovascular benefit, rather than reducing serum uric acid
.
Therefore, the status of dietary control needs to be strengthened: any dietary recommendations for hyperuricemia and gout should simultaneously provide cardiometabolic benefits to reduce excessive morbidity and mortality; promote healthy eating patterns; Purine diet; dietary recommendations for Chinese 2021 and US residents (2020-2025); Mediterranean diet and DASH diet; personalized gout diet recommendations
.
Mediterranean diet
