Abstract
The Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate (SU); however, the impact of the DASH diet has not been previously evaluated among patients with gout. We conducted a randomized, controlled, crossover pilot study to test the effects of ~$105/week ($15/day) of dietitian-directed groceries (DDG), patterned after the DASH diet, on SU, compared with self-directed grocery shopping (SDG). Participants had gout and were not taking urate lowering therapy. Each intervention period lasted 4 weeks; crossover occurred without a washout period. The primary endpoint was SU. Compliance was assessed by end-of-period fasting spot urine potassium and sodium measurements and self-reported consumption of daily servings of fruit and vegetables. We randomized 43 participants (19% women, 49% black, mean age 59 years) with 100% follow-up. Mean baseline SU was 8.1 mg/dL (SD, 0.8). During Period 1, DDG lowered SU by 0.55 mg/dL (95% CI: 0.07, 1.04) compared to SDG by 0.0 mg/dL (95% CI: −0.44, 0.44). However, after crossover (Period 2), the SU difference between groups was the opposite: SDG reduced SU by −0.48 mg/dL (95% CI: −0.98, 0.01) compared to DDG by −0.05 mg/dL (95% CI: −0.48, 0.38; P for interaction by period = 0.11). Nevertheless, DDG improved self-reported intake of fruit and vegetables (3.1 servings/day; 95% CI: 1.5, 4.8) and significantly reduced total spot urine sodium excretion by 22 percentage points (95% CI: −34.0, −8.6). Though relatively small in scale, this pilot study suggests that dietitian-directed, DASH-patterned groceries may lower SU among gout patients not on urate-lowering drugs. However, behavior intervention crossover trials without a washout period are likely vulnerable to strong carryover effects. Definitive evaluation of the DASH diet as a treatment for gout will require a controlled feeding trial, ideally with a parallel-design.
Highlights
The disease burden of gout has been increasing worldwide, a trend thought to be driven by concurrent epidemics in obesity and Western lifestyle [1,2,3,4]
The Dietary Approaches to Stop Hypertension Diet Effects on Serum Uric Acid (SU) in Adults with Hyperuricemia and Gout (DIGO) was an investigator-initiated, randomized crossover trial conducted in Baltimore, Maryland
In the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial, we found that the DASH diet lowered serum urate (SU) by 1.3 mg/dL among adults with a baseline value ≥ 7 mg/dL [15]
Summary
The disease burden of gout has been increasing worldwide, a trend thought to be driven by concurrent epidemics in obesity and Western lifestyle [1,2,3,4]. Diet has long been implicated in the pathogenesis of gout, including a higher intake of meat, seafood, sugar-sweetened beverages, and overall Western-dietary pattern [5,6,7,8]. The Dietary Approaches to Stop Hypertension (DASH) diet, a dietary pattern emphasizing fruit, vegetables, and low-fat dairy products that is proven to reduce blood pressure and low density lipoprotein cholesterol (LDLcholesterol), [12,13] has been associated with a lower risk of gout among men, [14] and has been shown to lower SU by 0.35 mg/dL overall among those with a SU level of 5 mg/dL at baseline and by over 1 mg/dL in those with an elevated SU [15,16]. Whether a DASH-patterned diet improves SU in gout patients has not been previously demonstrated
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