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Abstract Number: 2014

Effect of a Whole Food Plant-Based Diet in Patients with Gout: A Pilot Randomized Controlled Trial

Anna Kretova1, Carlijn Wagenaar1, Wendy Walrabenstein2, Daisy Vedder2, Dirkjan van Schaardenburg2 and Martijn Gerritsen1, 1Reade Rheumatology Center, Amsterdam, Netherlands, 2Amsterdam UMC, Amsterdam, Netherlands

Meeting: ACR Convergence 2024

Keywords: diet, gout, health behaviors, nutrition, Uric Acid, Urate

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Session Information

Date: Monday, November 18, 2024

Title: Metabolic & Crystal Arthropathies – Basic & Clinical Science Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: An unhealthy diet is an important modifiable risk factor for hyperuricemia and gout and is also associated with obesity and metabolic syndrome (MetS), known risk factors for gout as well as for cardiovascular disease (CVD). The prevalence of CVD is considerably elevated in patients with gout. A Mediterranean-style whole food plant-based diet (WFPD) has been shown to be effective for the treatment of other MetS- and obesity-related diseases. We therefore aimed to investigate the effect of a dietary intervention based on a WFPD on serum uric acid (SUA), gout disease activity and cardiovascular risk in patients with gout.

Methods: In the DIEGO (A DIEt for the treatment of GOut) pilot randomized clinical trial, patients with gout, hyperuricemia (♂ ≥ 0,42 mmol/L and ♀ ≥ 0,36 mmol/L), abdominal obesity (waist circumference ♂ ≥ 102 cm and ♀ ≥ 88 cm), and not receiving urate lowering therapy were assigned to the DIEGO WFPD intervention group or a usual care control group. The DIEGO group received individual counseling from a registered dietitian (60 min. at baseline, 30 min. in week 2, 4, 8, 12) and followed a Mediterranean-style WFPD for 16 weeks. Participants were allowed to use their usual gout flare medication during a gout flare. The primary outcome was the SUA level. Secondary outcomes included gout disease activity, cardiovascular risk factors and several other metabolic markers. An intention-to-treat analysis with a linear mixed model, adjusted for baseline values was used to analyze the between-group differences of primary and secondary continuous outcomes at 16 weeks.

Results: Of 54 people screened, 36 were randomized and 31 completed the study (DIEGO group: n=18). Overall, 92% of participants were male, with a mean (SD) age of 52 (12) years and a mean (SD) BMI of 33 (4) kg/m2. After 16 weeks the DIEGO group had significantly lower SUA levels (–0.03 mmol/L 95% CI –0.06 to –0.00, p=0.03; –0.05 mmol/L 95% CI –0.08 to –0.02; p=0.004 after adjustment for age, sex and BMI) as compared to the control group (Table 1). In total 23 gout flares occurred during the study, 11 in the DIEGO group and 12 in the control group. The mean (SD) duration (days) and flare intensity (VAS range 0 least to 10 worst) in the DIEGO group were 5.6 (2.3) and 6.2 (1.8) respectively vs 4.6 (2.7) and 6.7 (1.6) in the control group. Overall gout severity and pain (VAS range 0 least to10 worst) were significantly lower in the DIEGO group vs. control group: –2.0 (95% CI –6.0 to –1.0) and –2.0 (95% CI –5.0 to –0.0) respectively. Compared to the control group, the DIEGO group had a lower body weight, reduced waist circumference and improved LDL cholesterol at the end of the study. The change in systolic blood pressure (SBP) was not different between the groups, however the SBP reduced significantly within the DIEGO group and not in the control group. HbA1c, CRP, and diastolic blood pressure remained unchanged. No serious adverse events occurred during the study.

Conclusion: The Mediterranean-style WFPD significantly decreased SUA in patients with gout and abdominal obesity. In addition, following the Mediterranean-style WFPD resulted in decreased gout severity and pain, significant weight loss, decreased waist circumference, and improved LDL cholesterol, thus reducing the risk for CVD.

Supporting image 1

Continuous variables reported as mean (SD) when normally distributed or as median (IQR) when skewed. Between-group difference shown at the end of the dietary intervention determined using the linear-mixed model adjusted for baseline values. Outcomes were similar after adjusting for sex, age, and baseline Body Mass Index (BMI) (weight, BMI, and waist circumference not adjusted for BMI), except pain (non-significant after adjustment). Within group differences were assessed with a paired T-test when normally distributed or a Wilcoxon rank test when skewed. For variables in which model assumptions were not met (†) a linear-mixed model was performed after log(x + 1) transformation and between differences were reported as median difference determined using a Wilcoxon test (p-values from the linear mixed model are shown, all were similar to the Wilcoxon test). VAS scores range 0 (least) to 10 (worst). Significant within-group differences are reported (*) when p<0.05.


Disclosures: A. Kretova: None; C. Wagenaar: Plants for Health B.V., 4; W. Walrabenstein: Plants for Health, 8; D. Vedder: None; D. van Schaardenburg: Plants for Health B.V., 11; M. Gerritsen: Horizon Therapeutics, 5.

To cite this abstract in AMA style:

Kretova A, Wagenaar C, Walrabenstein W, Vedder D, van Schaardenburg D, Gerritsen M. Effect of a Whole Food Plant-Based Diet in Patients with Gout: A Pilot Randomized Controlled Trial [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/effect-of-a-whole-food-plant-based-diet-in-patients-with-gout-a-pilot-randomized-controlled-trial/. Accessed .
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