Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
Department of Medicine, Division of General Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
Am J Clin Nutr. 2021 Jun 1;113(6):1593-1599. doi: 10.1093/ajcn/nqaa424.
Dietary recommendations to prevent gout emphasize a low-purine diet. Recent evidence suggests that the Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate while also improving blood pressure and lipids.
To compare the effects of DASH-style diets emphasizing different macronutrient proportions on serum urate reduction.
We conducted a secondary analysis of the Optimal Macronutrient Intake Trial to Prevent Heart Disease feeding study, a 3-period, crossover design, randomized trial of adults with prehypertension or hypertension. Participants were provided with 3 DASH-style diets in random order, each for 6 wk. Each DASH-style diet emphasized different macronutrient proportions: a carbohydrate-rich (CARB) diet, a protein-rich (PROT) diet, and an unsaturated fat-rich (UNSAT) diet. In the PROT diet, approximately half of the protein came from plant sources. We compared the effects of these diets on serum urate at weeks 4 and 6 of each feeding period.
Of the 163 individuals included in the final analysis, the mean serum urate at baseline was 5.1 mg/dL. Only the PROT diet reduced serum urate from baseline at the end of the 6-wk feeding period (-0.16 mg/dL; 95% CI: -0.28, -0.04; P = 0.007). Neither the CARB diet (-0.03 mg/dL; 95% CI: -0.14, 0.09; P = 0.66) nor the UNSAT diet (-0.01 mg/dL; 95% CI: -0.12, 0.09; P = 0.78) reduced serum urate from baseline. The PROT diet lowered serum urate by 0.12 mg/dL (95% CI: -0.20, -0.03; P = 0.006) compared with CARB and by 0.12 mg/dL (95% CI: -0.20, -0.05; P = 0.002) compared with UNSAT.
A DASH-style diet emphasizing plant-based protein lowered serum urate compared with those emphasizing carbohydrates or unsaturated fat. Future trials should test the ability of a DASH-style diet emphasizing plant-based protein to lower serum urate and prevent gout flares in patients with gout. This trial was registered at clinicaltrials.gov as NCT00051350.
预防痛风的饮食建议强调低嘌呤饮食。最近的证据表明，膳食方法阻止高血压（DASH）饮食可降低血清尿酸水平，同时改善血压和血脂。
比较强调不同宏量营养素比例的 DASH 饮食对降低血清尿酸的影响。
我们对预防心脏病的最佳宏量营养素摄入试验（Optimal Macronutrient Intake Trial to Prevent Heart Disease，Omit）进行了二次分析，这是一项针对高血压前期或高血压成年人的 3 期交叉设计随机试验。参与者以随机顺序接受 3 种 DASH 饮食，每种饮食持续 6 周。每种 DASH 饮食强调不同的宏量营养素比例：富含碳水化合物（CARB）的饮食、富含蛋白质（PROT）的饮食和富含不饱和脂肪（UNSAT）的饮食。在 PROT 饮食中，大约一半的蛋白质来自植物来源。我们比较了这些饮食在每个喂养期的第 4 和第 6 周对血清尿酸的影响。
在最终分析的 163 名参与者中，基线时的平均血清尿酸为 5.1mg/dL。只有 PROT 饮食在 6 周喂养期结束时使血清尿酸从基线水平下降（-0.16mg/dL；95%CI：-0.28，-0.04；P=0.007）。CARB 饮食（-0.03mg/dL；95%CI：-0.14，0.09；P=0.66）和 UNSAT 饮食（-0.01mg/dL；95%CI：-0.12，0.09；P=0.78）均未使血清尿酸从基线水平降低。与 CARB 相比，PROT 饮食使血清尿酸降低 0.12mg/dL（95%CI：-0.20，-0.03；P=0.006），与 UNSAT 相比降低 0.12mg/dL（95%CI：-0.20，-0.05；P=0.002）。
与强调碳水化合物或不饱和脂肪的 DASH 饮食相比，强调植物性蛋白质的 DASH 饮食可降低血清尿酸。未来的试验应测试强调植物性蛋白质的 DASH 饮食降低血清尿酸和预防痛风患者痛风发作的能力。本试验在 clinicaltrials.gov 注册为 NCT00051350。
