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a Rheumatology Unit,
Milpark Hospital, Pain Relief and Research Unit, CH Baragwanath
Hospital, University of Witwatersrand, Johannesburg, South Africa, b Pain Relief and Research
Unit, CH Baragwanath Hospital, c Department of Rheumatology, Johannesburg
Hospital, University of Witwatersrand, Johannesburg, South Africa, d Carbohydrate
and Lipid Metabolism Research Unit, Johannesburg Hospital, e Department of Quantitative Management,
UNISA, Pretoria, South Africa
Correspondence to: Dr P Dessein, PO Box 1012, Melville 2109, Johannesburg, South Africa Email: Dessein{at}elink.co.za
Accepted for publication 20 January 2000
OBJECTIVES
Insulin
resistance (IR) has been increasingly implicated in the pathogenesis of
gout. The lipoprotein abnormalities described in hyperuricaemic
subjects are similar to those associated with IR, and insulin
influences renal urate excretion. In this study it was investigated
whether dietary measures, reported to be beneficial in IR, have serum
uric acid (SU) and lipid lowering effects in gout.
METHODSThirteen
non-diabetic men (median age 50, range 38-62) were enrolled. Each
patient had had at least two gouty attacks during the four months
before enrolment. Dietary recommendations consisted of calorie
restriction to 6690 kJ (1600 kcal) a day with 40% derived from
carbohydrate, 30% from protein, and 30% from fat; replacement of
refined carbohydrates with complex ones and saturated fats with mono-
and polyunsaturated ones. At onset and after 16 weeks, fasting blood
samples were taken for determination of SU, serum cholesterol (C), low
density lipoprotein cholesterol (LDL-C), high density lipoprotein
cholesterol (HDL-C), and triglycerides (TGs). Results were expressed as
median (SD).
RESULTSAt onset, the
body mass index (BMI) was 30.5 (8.1) kg/m2. Dietary
measures resulted in weight loss of 7.7 (5.4) kg (p=0.002) and a
decrease in the frequency of monthly attacks from 2.1 (0.8) to 0.6 (0.7) (p=0.002). The SU decreased from 0.57 (0.10) to 0.47 (0.09)
mmol/l (p=0.001) and normalised in 7 (58%) of the 12 patients with an
initially raised level. Serum cholesterol decreased from 6.0 (1.7) to
4.7 (0.9) mmol/l (p=0.002), LDL-C from 3.5 (1.2) to 2.7 (0.8) mmol/l
(p=0.004), TGs from 4.7 (4.2) to 1.9 (1.0) mmol/l (p=0.001), and
C:HDL-C ratios from 6.7 (1.7) to 5.2 (1.0) (p=0.002). HDL-C levels
increased insignificantly. High baseline SU, frequency of attacks,
total cholesterol, LDL-C and TG levels, and total C:HDL-C ratios
correlated with higher decreases in the respective variables upon
dietary intervention (p<0.05).
CONCLUSIONThe results
suggest that weight reduction associated with a change in proportional
macronutrient intake, as recently recommended in IR, is beneficial,
reducing the SU levels and dyslipidaemia in gout. Current dietary
recommendations for gout may need re-evaluation.
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