Nutrition and lifestyle in gout and hyperuricemia patients: Updated recommendations
Austria: The Austrian Society of Rheumatology and Rehabilitation has released updated nutrition and lifestyle recommendations for patients with gout and hyperuricemia. The recommendations were published in the Central European Journal of Medicine on 11 July 2022.
Gout is the most common inflammatory joint disease in the western world and has a proven genetic background. Additionally, a number of lifestyle factors contribute to the rising incidence of hyperuricemia and gout. The factors include increasing life span and wealth, sufficient excess nutritional status, and a growing prevalence of obesity in the population. Other than an adequate medication regime, medical advice on nutrition and lifestyle is an essential part of the management of gout patients, who are at high risk of internal comorbidities.
In 2015, the ÖGR (Österreichische Gesellschaft für Rheumatologie und Rehabilitation) working group for osteoarthritis and crystal arthropathies already published nutrition and lifestyle recommendations for patients with gout and hyperuricemia. Since then, many studies have been published addressing the topic, hence the need for an update.
For developing the recommendations, a hierarchical literature search was performed to screen the meanwhile published literature. Also considering references of the first publication, the relevant literature was selected, and the 2015 recommendations were either kept as published, reformulated, or newly produced. Finally, the evidence level and the level of agreement with each recommendation were added.
Finally, ten recommendations were generated instead of the initial nine. The recommendations were as follows:
- Weight gain and obesity can lead to an increase in SUA levels and gout. In the case of adiposity, gradual weight loss (at least in men) can help lower SUA levels and thus protect against gout.
- Both gout and hyperuricemia are associated with cardiometabolic and renal comorbidities. Therefore, regular physical exercise/cardiovascular training (150 (–300) min/week of moderate-intensity) is recommended in addition to weight control and dietary measures.
- A healthy diet such as the dietary approaches to stop hypertension (DASH) diet, in combination with weight reduction if the patient is overweight, can positively influence gout incidence, elevated SUA levels, and cardiometabolic risk.
- Red meat, offal, and sausage products can increase SUA levels and thereby increase the risk of gout. For this reason, red meat and associated products should be eaten less frequently (2 ×/week) and only in small quantities. The consumption of purine-rich vegetables is explicitly recommended.
- Seafood (especially crustaceans and mussels) can increase SUA levels and therefore the risk of gout and should therefore be consumed sparingly. Fish is recommended for consumption on a regular basis (1–2 ×/per week) as part of a generally healthy diet and also to help avoid cardiovascular disease.
- Drinking alcohol increases the risk of gout in a dose-dependent manner. Beer and spirits, in particular, should be avoided, while red wine has the least potential for increasing the risk of gout.
- Sugary soft drinks, fruit juices, and high-fructose foods (fruit sugars) can increase SUA levels and should therefore be avoided. Fresh fruit and fructose-free "light drinks" do not increase the risk of gout.
- Regular consumption of (low-fat) milk/dairy products can lower SUA levels and is recommended for all gout patients.
- Regular consumption of coffee can help to lower SUA levels—in combination with proper diet and medication—and is, therefore, to be advocated.
- Cherries (especially the Montmorency variety) can lower SUA levels by promoting urinary excretion. However, it is still unclear at what dose the different products (juice, concentrate, extract) yield the most desirable effect. It is possible that sour cherries in combination with allopurinol have a complementary effect.
The authors conclude, "the Austrian nutrition and lifestyle recommendations for patients with gout and hyperuricemia were updated incorporating the most recent relevant literature, serving as education material for patients and updated information for physicians."
Reference:
Sautner, J., Eichbauer-Sturm, G., Gruber, J. et al. 2022 update of the Austrian Society of Rheumatology and Rehabilitation nutrition and lifestyle recommendations for patients with gout and hyperuricemia. Wien Klin Wochenschr (2022). https://doi.org/10.1007/s00508-022-02054-7
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