Suche
Relation
Rai SK, Fung TT, Lu N, et al. The Dietary Approaches to Stop Hypertension (DASH), the Western diet and the risk of gout in men: prospective cohort study.BMJ. 2017;357:j1794.
Draft
Prospective cohort study
Objective
To look for associations between the DASH diet (Dietary Approaches to Stop Hypertension), the Western diet and the risk of gout in men.
Participant
A total of 44,444 men from the ongoing longitudinal Health Professionals Follow-up Study (HPFS) were included in this cohort. When HPFS was founded in 1986, men were predominantly white (91%) and between 40 and 75 years old. In each 2-year assessment cycle since the inception of the HPFS, there has been an eligibility rate of over 90%. Only men who provided complete information about dietary habits and had no history of gout were included in this study.
Study parameters assessed
Data from food frequency questionnaires were used to create both a DASH dietary pattern and a Western dietary pattern score for each participant. The DASH dietary pattern is high in fruits, vegetables, nuts, legumes, low-fat dairy products, and whole grains and low in sodium, sweetened beverages, and red and processed meats. A Western dietary pattern is high in red and processed meats, fried foods, simple carbohydrates and sweets.
Target parameters
The primary outcome was risk of gout; Risk was assessed using the American College of Rheumatology preliminary survey criteria, adjusting for potential confounders (e.g., age, body mass index [BMI], hypertension, and alcohol consumption).
Key insights
Compared to men with a higher Western dietary pattern score, the men with a higher DASH dietary pattern had a significantly lower risk of developing gout in both age-adjusted and multivariable regression models and after adjusting for other risk factors associated with gout, such as alcohol consumption and body mass index (BMI).
The DASH diet is particularly intriguing because it addresses common comorbidities associated with gout.
To estimate the relative risk, the researchers categorized the dietary pattern results into fifths. The gout risk score for men in the highest quintile compared to the lowest quintile was 0.68 (P<0.001) in the DASH group and 1.42 (P=0.005) in the Western diet group. Men with a higher Western dietary pattern had a significantly increased risk of developing gout. High BMI, high alcohol consumption and high coffee consumption were also associated with increased risk. Men in the top fifth of the DASH group consumed less alcohol and coffee, tended to be older and had a lower BMI.
Practice implications
Interestingly, this year marks the 20th anniversary of the introduction of the Dietary Approaches to Stop Hypertension (DASH) diet, considered a major nutritional advance in cardiovascular health.1According to the National Institutes of Health (NIH), compared to the typical American diet, the DASH diet contains more fruits, vegetables, fat-free or low-fat milk and dairy products, whole grains, fish, poultry, beans, seeds, and nuts, with less sodium, sweets, sugary drinks, fats and red meat.2
Over the past 2 decades, clinical studies have consistently shown that the DASH diet can help lower blood pressure.1This present study adds to emerging research linking the DASH diet to lower serum uric acid levels compared to the Standard American Diet, suggesting that DASH may be a useful intervention in patients with gout or at risk of developing gout.3.4
Gout is a form of arthritis that can cause severe pain, swelling, redness, and inflammation of a joint, often the big toe joint. About 6 million adults in the United States have gout, and it primarily affects men ages 40 to 50.5The incidence of gout has been steadily increasing in many parts of the world, including the United States.6This may be due in part to the corresponding increase in obesity and poor dietary habits.
In addition to anti-inflammatory over-the-counter medications for acute attacks, clinicians often recommend dietary changes to reduce risk and reduce flare-ups. The “gold standard” recommendation is to avoid foods high in purines, such as processed meats, gravy, and beer.7However, some studies indicate that foods rich in purines are not the problem and suggest that refined fructose could be a culprit, particularly in drinks.8.9
The DASH diet is particularly intriguing because it addresses common comorbidities associated with gout. Individuals with gout have higher rates of cardiovascular comorbidities, including hypertension, which the DASH diet specifically targets. In addition, gout sufferers have a 63% increased risk of metabolic syndrome.10,11As the researchers of this present study point out, although individual dietary risk factors for hyperuricemia and gout have been identified, a “piecemeal approach to modifying the diverse but limited number of specific dietary risk factors is often ineffective and impractical.”12Additionally, without guidance on healthy calorie replacement, the low-purine diet can result in a high-carbohydrate diet, further increasing the risk of metabolic syndrome.13
As with any diet, compliance and sustainability are pivotal points when it comes to effectiveness. In a study of patients with high blood pressure, participants actually enjoyed the DASH diet so much that they said they would be willing to continue it long-term.14
This present study provides further evidence that the typical American diet exacerbates gout risk and flare-ups and demonstrates that the DASH diet is a viable and sustainable intervention for these patients. It may not be the only diet capable of doing this, but this is the first prospective study to suggest that the DASH diet may reduce the risk of gout.