Division of Rheumatology, University of Washington, Seattle, WA, USA.
Adv Chronic Kidney Dis. 2012 Nov;19(6):392-7. doi: 10.1053/j.ackd.2012.07.011.
The epidemiology of gout has changed dramatically over the past century. Once thought of as a disease of the nobility, it is now an egalitarian disease that affects patients across the socioeconomic spectrum. The incidence of gout has also risen in recent years, to the point that we are now seeing what is regarded by some as a "second epidemic" of gout. This change coincides with a significant dietary shift for many Americans - in particular, the advent of high-fructose corn syrup as the most prominent sweetener in the modern American diet and what may be a related rise in obesity. Fructose is a powerful driver of ATP catabolism that, in turn, leads to the production of uric acid. The new epidemic of gout is likely secondary in significant part to the rise in fructose consumption, as well as to the increase in obesity, the endurance of other dietary and non-dietary gout risk factors such as consumption of meat and alcohol, the continued use of culprit medications and potentially to the under-recognition of the benefits of certain foods and drinks (such as dairy products and coffee). Though the exact reasons for the rise in gout are yet unproven, this reopens the opportunity for dietary control of hyperuricemia through restraints that curtail not only exogenous but also endogenous pathways of purine production.
痛风的流行病学在过去一个世纪发生了巨大变化。曾经被认为是贵族的疾病，现在已经成为一种平等主义的疾病，影响着社会经济各个层面的患者。近年来，痛风的发病率也有所上升，以至于我们现在看到的是一些人认为的痛风“第二次流行”。这种变化与许多美国人饮食的重大转变相吻合——特别是，高果糖玉米糖浆作为现代美国饮食中最突出的甜味剂的出现，以及肥胖率的上升可能与此有关。果糖是三磷酸腺苷分解代谢的强大驱动力，反过来又导致尿酸的产生。痛风的新流行在很大程度上可能是由于果糖消费的增加以及肥胖的增加、肉类和酒精等其他饮食和非饮食痛风危险因素的持续消费、对某些食物和饮料（如乳制品和咖啡）的益处的认识不足所导致的。虽然痛风发病率上升的确切原因尚未得到证实，但这为通过限制嘌呤产生的外源性和内源性途径来控制高尿酸血症提供了新的机会。
