A Perspective on Diet and Gout
A Perspective on Diet and Gout
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DOI：
10.1053/j.ackd.2012.07.011
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发表时间：
2012-11-01
影响因子：
2.9
通讯作者：
Simkin, Peter A.
中科院分区：
文献类型：
--
作者：
Kedar, Eyal;Simkin, Peter A.
在过去的世纪，痛风的流行病学发生了巨大的变化。曾经被认为是贵族的疾病，现在它是一种平等主义的疾病，影响着整个社会经济领域的患者。痛风的发病率近年来也有所上升，以至于我们现在看到的是被一些人认为是痛风的“第二次流行”。这一变化与许多美国人的重大饮食转变相吻合，特别是高果糖玉米糖浆作为现代美国饮食中最重要的甜味剂的出现，以及肥胖症的相关增加。果糖是ATP催化剂的强大驱动力，这反过来又导致尿酸的产生。痛风的新流行可能是次要的，在很大程度上是果糖消费量的增加，以及肥胖的增加，其他饮食和非饮食痛风风险因素的耐受性，如肉类和酒精的消费，继续使用罪魁祸首药物，并可能对某些食物和饮料（如乳制品和咖啡）的好处认识不足。虽然痛风发病率上升的确切原因尚未得到证实，但这为通过限制嘌呤产生的外源性和内源性途径来控制高尿酸血症提供了机会。(C)2012年，美国国家肾脏基金会（National Kidney Foundation，Inc.）All rights reserved.
The epidemiology of gout has changed dramatically over the past century. Once thought of as a disease of the nobility, it is now an egalitarian disease that affects patients across the socioeconomic spectrum. The incidence of gout has also risen in recent years, to the point that we are now seeing what is regarded by some as a "second epidemic" of gout. This change coincides with a significant dietary shift for many Americans in particular, the advent of high-fructose corn syrup as the most prominent sweetener in the modern American diet and what may be a related rise in obesity. Fructose is a powerful driver of ATP catabolism that, in turn, leads to the production of uric acid. The new epidemic of gout is likely secondary in significant part to the rise in fructose consumption, as well as to the increase in obesity, the endurance of other dietary and non-dietary gout risk factors such as consumption of meat and alcohol, the continued use of culprit medications and potentially to the under-recognition of the benefits of certain foods and drinks (such as dairy products and coffee). Though the exact reasons for the rise in gout are yet unproven, this reopens the opportunity for dietary control of hyperuricemia through restraints that curtail not only exogenous but also endogenous pathways of purine production. (C) 2012 by the National Kidney Foundation, Inc. All rights reserved.