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, 11 (12)

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

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Review

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

Daisy Vedder et al. Nutrients.

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.

Keywords: DASH; Mediterranean diet; blood pressure; cardiovascular disease; cholesterol; diet; gout; hyperuricemia; metabolic syndrome x; purine low diet.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the systematic literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method on diet and hyperuricemia and/or gout.
Figure 2
Figure 2
Assessment risk of bias of randomized controlled trials included in this review according to the Cochrane Collaboration’s tool. Red: high risk, yellow: moderate risk, green: low risk, grey: no information or unclear risk.
Figure 3
Figure 3
Assessment risk of bias of non-randomized studies included in this review according to the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool. Red: high/critical risk, yellow: moderate risk, green: low risk, grey: no information or unclear risk.

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