Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study
Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study
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DOI：
10.1136/ard.59.7.539
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发表时间：
2000-07-01
影响因子：
27.4
通讯作者：
Ramokgadi, J
中科院分区：
文献类型：
--
作者：
Dessein, PH;Shipton, EA;Ramokgadi, J
目的——胰岛素抵抗（IR）越来越多地与痛风的发病机制有关。高尿酸血症受试者中描述的脂蛋白异常与IR相关的脂蛋白异常相似，并且胰岛素影响肾脏尿酸盐排泄。在这项研究中，调查了据报道对 IR 有益的饮食措施是否对痛风具有降低血清尿酸 (SU) 和血脂的作用。方法 - 招募了 13 名非糖尿病男性（中位年龄 50 岁，范围 38-62 岁）。每个患者在入组前的四个月内至少有过两次痛风发作，饮食建议包括每天热量限制在 6690 kJ（1600 kcal），其中 40% 来自碳水化合物，30% 来自蛋白质，30% 来自脂肪；用复合碳水化合物代替精制碳水化合物，用单不饱和脂肪和多不饱和脂肪代替饱和脂肪。发病时和16周后，采集空腹血样测定SU、血清胆固醇(C)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和甘油三酯(TG)。结果以中位数（SD）表示。结果-发病时，体重指数（BMI）为30.5（8.1）kg/m（2）。饮食措施使体重减轻了 7.7 (5.4) 公斤 (p = 0.002)，每月发作频率从 2.1 (0.8) 减少到 0.6 (0.7) (p = 0.002)。 SU 从 0.57 (0.10) 降低至 0.47 (0.09) mmol/l (p = 0.001)，并在 12 名最初水平升高的患者中，有 7 名 (58%) 恢复正常。血清胆固醇从 6.0 (1.7) 降低至 4.7 (0.9) mmol/l (p = 0.002)，LDL-C 从 3.5 (1.2) 降低至 2.7 (0.8) mmol/l (p = 0.004)，TG 从 4.7 (4.2) 降低至 1.9 (1.0) mmol/l (p = 0.001)，并且C:HDL-C 比率从 6.7 (1.7) 到 5.2 (1.0) (p = 0.002)。 HDL-C 水平无显着增加。高基线 SU、发作频率、总胆固醇、LDL-C 和 TC 水平以及总 C:HDL-C 比率与饮食干预后各个变量的较高下降相关 (p < 0.05)。结论 - 结果表明，正如最近在 IR 中建议的那样，与宏量营养素摄入比例变化相关的体重减轻是有益的，可降低痛风中的 SU 水平和血脂异常。目前的痛风饮食建议可能需要重新评估。
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.Methods-Thirteen 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).Results- At onset, the body mass index (BMI) was 30.5 (8.1) kg/m(2). 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 TC levels, and total C:HDL-C ratios correlated with higher decreases in the respective variables upon dietary intervention (p < 0.05).Conclusion-The 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.