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A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout

The Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate (SU); however, the impact of the DASH diet has not been previously evaluated among patients with gout. We conducted a randomized, controlled, crossover pilot study to test the effects of ~$105/week ($15/day) of dietitian-dir...

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Autores principales: Juraschek, Stephen P., Miller, Edgar R., Wu, Beiwen, White, Karen, Charleston, Jeanne, Gelber, Allan C., Rai, Sharan K., Carson, Kathryn A., Appel, Lawrence J., Choi, Hyon K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914968/
https://www.ncbi.nlm.nih.gov/pubmed/33562216
http://dx.doi.org/10.3390/nu13020538
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author Juraschek, Stephen P.
Miller, Edgar R.
Wu, Beiwen
White, Karen
Charleston, Jeanne
Gelber, Allan C.
Rai, Sharan K.
Carson, Kathryn A.
Appel, Lawrence J.
Choi, Hyon K.
author_facet Juraschek, Stephen P.
Miller, Edgar R.
Wu, Beiwen
White, Karen
Charleston, Jeanne
Gelber, Allan C.
Rai, Sharan K.
Carson, Kathryn A.
Appel, Lawrence J.
Choi, Hyon K.
author_sort Juraschek, Stephen P.
collection PubMed
description The Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate (SU); however, the impact of the DASH diet has not been previously evaluated among patients with gout. We conducted a randomized, controlled, crossover pilot study to test the effects of ~$105/week ($15/day) of dietitian-directed groceries (DDG), patterned after the DASH diet, on SU, compared with self-directed grocery shopping (SDG). Participants had gout and were not taking urate lowering therapy. Each intervention period lasted 4 weeks; crossover occurred without a washout period. The primary endpoint was SU. Compliance was assessed by end-of-period fasting spot urine potassium and sodium measurements and self-reported consumption of daily servings of fruit and vegetables. We randomized 43 participants (19% women, 49% black, mean age 59 years) with 100% follow-up. Mean baseline SU was 8.1 mg/dL (SD, 0.8). During Period 1, DDG lowered SU by 0.55 mg/dL (95% CI: 0.07, 1.04) compared to SDG by 0.0 mg/dL (95% CI: −0.44, 0.44). However, after crossover (Period 2), the SU difference between groups was the opposite: SDG reduced SU by −0.48 mg/dL (95% CI: −0.98, 0.01) compared to DDG by −0.05 mg/dL (95% CI: −0.48, 0.38; P for interaction by period = 0.11). Nevertheless, DDG improved self-reported intake of fruit and vegetables (3.1 servings/day; 95% CI: 1.5, 4.8) and significantly reduced total spot urine sodium excretion by 22 percentage points (95% CI: −34.0, −8.6). Though relatively small in scale, this pilot study suggests that dietitian-directed, DASH-patterned groceries may lower SU among gout patients not on urate-lowering drugs. However, behavior intervention crossover trials without a washout period are likely vulnerable to strong carryover effects. Definitive evaluation of the DASH diet as a treatment for gout will require a controlled feeding trial, ideally with a parallel-design.
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spelling pubmed-79149682021-03-01 A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout Juraschek, Stephen P. Miller, Edgar R. Wu, Beiwen White, Karen Charleston, Jeanne Gelber, Allan C. Rai, Sharan K. Carson, Kathryn A. Appel, Lawrence J. Choi, Hyon K. Nutrients Article The Dietary Approaches to Stop Hypertension (DASH) diet reduces serum urate (SU); however, the impact of the DASH diet has not been previously evaluated among patients with gout. We conducted a randomized, controlled, crossover pilot study to test the effects of ~$105/week ($15/day) of dietitian-directed groceries (DDG), patterned after the DASH diet, on SU, compared with self-directed grocery shopping (SDG). Participants had gout and were not taking urate lowering therapy. Each intervention period lasted 4 weeks; crossover occurred without a washout period. The primary endpoint was SU. Compliance was assessed by end-of-period fasting spot urine potassium and sodium measurements and self-reported consumption of daily servings of fruit and vegetables. We randomized 43 participants (19% women, 49% black, mean age 59 years) with 100% follow-up. Mean baseline SU was 8.1 mg/dL (SD, 0.8). During Period 1, DDG lowered SU by 0.55 mg/dL (95% CI: 0.07, 1.04) compared to SDG by 0.0 mg/dL (95% CI: −0.44, 0.44). However, after crossover (Period 2), the SU difference between groups was the opposite: SDG reduced SU by −0.48 mg/dL (95% CI: −0.98, 0.01) compared to DDG by −0.05 mg/dL (95% CI: −0.48, 0.38; P for interaction by period = 0.11). Nevertheless, DDG improved self-reported intake of fruit and vegetables (3.1 servings/day; 95% CI: 1.5, 4.8) and significantly reduced total spot urine sodium excretion by 22 percentage points (95% CI: −34.0, −8.6). Though relatively small in scale, this pilot study suggests that dietitian-directed, DASH-patterned groceries may lower SU among gout patients not on urate-lowering drugs. However, behavior intervention crossover trials without a washout period are likely vulnerable to strong carryover effects. Definitive evaluation of the DASH diet as a treatment for gout will require a controlled feeding trial, ideally with a parallel-design. MDPI 2021-02-07 /pmc/articles/PMC7914968/ /pubmed/33562216 http://dx.doi.org/10.3390/nu13020538 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Juraschek, Stephen P.
Miller, Edgar R.
Wu, Beiwen
White, Karen
Charleston, Jeanne
Gelber, Allan C.
Rai, Sharan K.
Carson, Kathryn A.
Appel, Lawrence J.
Choi, Hyon K.
A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout
title A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout
title_full A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout
title_fullStr A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout
title_full_unstemmed A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout
title_short A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout
title_sort randomized pilot study of dash patterned groceries on serum urate in individuals with gout
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914968/
https://www.ncbi.nlm.nih.gov/pubmed/33562216
http://dx.doi.org/10.3390/nu13020538
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