Yun Gao, MD, and Xiang Gao, MD, PhD, on the DASH Diet and Hyperuricemia
Several nutrients and foods are associated with uric acid status. However, the association between overall diet quality and hyperuricemia is unclear. A research team led by Yun Gao, MD, and Xiang Gao, MD, PhD, aimed to better understand this association.1
To conduct their study, the researchers evaluated data on 71,893 participants from the Kailuan Study who did not have gout prior to or during 2014. The researchers examined the association between adherence to the dietary approaches to stop hypertension (DASH) diet and odds of having hyperuricemia.
Findings from the study indicated that the DASH diet was associated with a lower likelihood of hyperuricemia in adults from China.
Rheumatology Consultant reached out to study co-authors Yun Gao, MD, and Xiang Gao, MD, PhD, about their research.
RHEUM CON: What do we know about the DASH diet and its impact on rheumatic disease?
Yun Gao, Xiang Gao: The DASH diet reflects overall dietary quality. It was originally designed to examine the effectiveness of an overall dietary pattern for reducing blood pressure. After that, a growing number of evidence suggested that the DASH diet could be associated with lower risk of hyperuricemia/gout, diabetes mellitus, and dyslipidemia. However, the potential impact of the DASH diet on rheumatoid arthritis and other rheumatic diseases needs further investigation.
RHEUM CON: Why is it important to understand the relationship between the DASH diet and hyperuricemia?
YG, XG: Hyperuricemia is common in the general population and is closely related to a high risk of mortality and several major chronic diseases, such as gout and cardiovascular diseases. A well-balanced, nutritious diet (nutrition therapy) remains a fundamental element of urate lowering therapy. Physicians often advise patients with hyperuricemia or gout to avoid purine-rich foods, limit medium-high purine foods, and encourage low-purine foods in clinical practice. However, increasing evidence shows that these dietary recommendations, which focus on single nutrients or foods, did not achieve the expected effect. Moreover, several studies based in the United States did not find significant association between purine-rich foods (eg, legume or soybean products) and uric acid status. This could be due to lack of variation in consumption of these foods. In the United States, few people regularly consume legume and soybean products. Diet intake is complex and overall diet quality, instead of single nutrients, could provide an overall picture of the association between diet and health outcomes. This is the reason we conducted this study.
RHEUM CON: What is important for rheumatologists to know about the findings?
YG, XG: For the prevention and treatment of hyperuricemia and/or gout, medical nutrition therapy is an important aspect of nonpharmacologic therapeutic approaches. The findings from the study could promote rheumatologists to take into account the association between adherence to DASH diet and low odds of having hyperuricemia. Moreover, rheumatologists could recommend DASH diet to individuals with hyperuricemia and/or gout in clinical practice. What’s more important, the findings remind rheumatologists to conduct clinical trials in order to confirm the causality of DASH diet and uric acid status. Of note, as we mentioned before, most previous US-based studies failed to document the significant association between consumption of legume and soybean products and high risk of hyperuricemia. This could be due the low consumption of these foods in western population. Our study thus is uniquely positioned to test this important clinical question.
RHEUM CON: The study findings indicated that the DASH diet was associated with a low likelihood of having hyperuricemia in Chinese adults. Do you think this diet can be applied to other ethnic groups? And other rheumatic diseases?
YG, XG: The DASH diet has been suggested to be associated with low risk of major chronic diseases (eg, hypertension and cardiovascular disease) in Caucasian and Asian populations. This suggests that our findings may be applied to other ethnic groups. However, more evidence from other ethnic groups are needed to replicate our findings.
RHEUM CON: What were the main limitations of the study?
YG, XG: The major limitation of the study is that it is a cross-sectional study. The causality of the observed association in this study could not be established. We cannot exclude possibility of reverse causality, that is, participants may change their dietary behaviors because of comorbidities related to elevated serum uric acid concentrations. The next steps of the research will be to conduct prospective studies to further evaluate the effect of DASH diet on the risk of gout.
Reference:
- Gao Y, Cui LF, Sun YY, et al. Adherence to the dietary approaches to stop hypertension (DASH) diet and hyperuricemia: a cross-sectional study [published online January 21, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24150.