Background/Purpose: There is a remarkable, increasing disease burden of gout and its
associated cardiovascular-metabolic comorbidities (e.g., hypertension in
74% of cases in the US), underscoring an urgent need for holistic
strategies to effectively address these conditions together.  The DASH diet, which emphasizes fruits, vegetables, low-fat dairy foods, and
reduced saturated and total fat, substantially reduces blood pressure
and is also recommended in dietary guidelines to prevent cardiovascular disease
(CVD).  This approach could also lower
SUA levels by its anti-hypertension effects and favorable urate-lowering
components, such as low-fat dairy foods. 
Thus, the DASH diet holds the remarkable promise of “killing two birds
with one stone” in the prevention of gout by improving both SUA outcomes and
its associated CVD complications. We investigated the SUA response to the DASH
diet as compared to a control diet over a 6 month period.  

Methods: The
DASH trial population consisted of adults
with stage 1 hypertension (not on any antihypertensive agents) who received
either the DASH diet, a fruit/vegetable-rich diet, or a control diet (reflective
of the average American diet) over the span of 8 weeks (NEJM 1997).  Sodium intake and body weight were maintained
at constant levels to isolate the diet’s effect. We measured SUA levels at
baseline and 8 weeks among 327 participants with complete datasets and analyzed
the SUA level response.  Since our
central objective was to examine the potential utility of the DASH diet in the
prevention of gout, our analyses had an a priori focus on high risk sub-groups
for gout at baseline (i.e., those with hyperuricemia, those who were overweight/obese,
and men).

Results: The
mean age was 44 years and the mean BMI was 28.1 kg/m². Most
participants (53%) were men. The overall dropout rate was <4%, and the overall
rate of adherence to the diets was > 93% during the 8-week study
period.  The mean baseline SUA level was 5.70
mg/dL, and the DASH diet reduced SUA levels by 0.24 mg/dL more than the
control diet (p = 0.01).  Among the 75
subjects with hyperuricemia (men: SUA > 7mg/dL, women: SUA > 6mg/dL), the
DASH diet reduced SUA levels by 0.59 mg/dL more than the control diet (p=0.005)
and 0.46 mg/dL more than the fruit/vegetable group (p=0.028).  Additional benefits included significant
improvements in systolic and diastolic blood pressure (Table).  For example,
among 75 subjects with hyperuricemia and hypertension, the DASH diet reduced
systolic and diastolic pressure by 5.0 and 3.3 mm Hg more, respectively, than
the control diet (P=0.008 and P=0.012 for each).

Conclusion: Our
findings suggest that the DASH diet can reduce SUA and blood pressure in high
risk groups for gout.  This diet offers
an additional nutritional approach to preventing (and potentially treating)
hyperuricemia and gout, as well as hypertension (a comorbidity present in 74%
of gout patients).