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

Objectives-Insulin resistance (IR) has been increasingly implicated in the pathogenesis of gout. The lipoprotein abnormalities described in hyperurica emic subjects are similar to those associated with IR, and insulin influenc es renal urate excretion. In this study it was investigated whether dietary measures, reported to be beneficial in IR, have serum uric acid (SU) and l ipid lowering effects in gout. Methods-Thirteen non-diabetic men (median age 50, range 38-62) were enrolle d. Each patient had had at least two gouty attacks during the four months b efore enrolment, Dietary recommendations consisted of calorie restriction t o 6690 kJ (1600 kcal) a day with 40% derived from carbohydrate, 30% from pr otein, and 30% from fat; replacement of refined carbohydrates with complex ones and saturated fats with mono- and polyunsaturated ones. At onset and a fter 16 weeks, fasting blood samples were taken for determination of SU, se rum cholesterol (C), low density lipoprotein cholesterol (LDL-C), high dens ity 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). Dietar y measures resulted in weight loss of 7.7 (5.4) kg (p = 0.002) and a decrea se in the frequency of monthly attacks from 2.1 (0.8) to 0.6 (0.7) (p = 0.0 02). The SU decreased from 0.57 (0.10) to 0.47 (0.09) mmol/l (p = 0.001) an d 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) t o 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:H DL-C ratios correlated with higher decreases in the respective variables up on dietary intervention (p < 0.05). Conclusion-The results suggest that weight reduction associated with a chan ge in proportional macronutrient intake, as recently recommended in IR, is beneficial, reducing the SU levels and dyslipidaemia in gout. Current dieta ry recommendations for gout may need re-evaluation.