Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya65799610.26442/00403660.2025.05.203227ReviewsОбзорыReview ArticleFeatures of diet in patients with cardiometabolic diseases with gout and hyperuricemia: A reviewОсобенности диеты у пациентов с кардиометаболическими заболеваниями при подагре и гиперурикемииhttps://orcid.org/0000-0002-3757-058XGromovaMargarita A.ГромоваМаргарита Александровна
Russian Federation

канд. мед. наук, доц. каф. факультетской терапии Института клинической медицины

margarita-gromov@mail.ruhttps://orcid.org/0000-0001-8040-3704TsurkoVladimir V.ЦуркоВладимир Викторович
Russian Federation

д-р мед. наук, проф. каф. факультетской терапии Института клинической медицины

margarita-gromov@mail.ruhttps://orcid.org/0000-0001-9262-9233StarodubovaAntonina V.СтародубоваАнтонина Владимировна
Russian Federation

д-р мед. наук, доц., зав. каф. факультетской терапии Института клинической медицины

margarita-gromov@mail.ruhttps://orcid.org/0000-0002-2028-8748KislyakOxana A.КислякОксана Андреевна
Russian Federation

д-р мед. наук, почетный проф. каф. факультетской терапии Института клинической медицины

margarita-gromov@mail.ruPirogov Russian National Research Medical University (Pirogov University)ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России (Пироговский Университет)08062025975Issues of rheumatologyВопросы ревматологии4554622002202520022025Copyright ©; 2025, Consilium MedicumCopyright ©; 2025, ООО "Консилиум Медикум"2025Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/657996

Gout, like hyperuricemia, is often associated with serious cardiometabolic and renal comorbidities that lead to persistently elevated rates of premature mortality in the population. Traditional dietary recommendations given to patients to prevent purine load require revision. This article holistically reviews the relevant scientific rationale and available evidence to provide evidence-based dietary recommendations for the prevention and treatment of hyperuricemia and gout and its cardiometabolic comorbidities.

Подагра, как и гиперурикемия, часто связана с серьезными кардиометаболическими и почечными сопутствующими заболеваниями, которые приводят к постоянно повышенным показателям преждевременной смертности в популяции. Традиционные диетические рекомендации, которые даются пациентам с целью предотвращения пуриновой нагрузки, требуют пересмотра. В этой статье целостно рассматриваются соответствующие научные обоснования и имеющиеся данные для предоставления основанных на доказательствах диетических рекомендаций по профилактике и лечению гиперурикемии и подагры, а также их кардиометаболических сопутствующих заболеваний.

gouthyperuricemiametabolic syndromecardiovascular diseasesdietnutritionподаграгиперурикемияметаболический синдромсердечно-сосудистые заболеваниядиетапитаниеRichette P, Bardin T. Gout. Lancet. 2010;375(9711):318-28. DOI:10.1016/S0140-6736(09)60883-7Yokose C, McCormick N, Choi HK. The role of diet in hyperuricemia and gout. Curr Opin Rheumatol. 2021;33(2):135-44. DOI:10.1097/BOR.0000000000000779Borghi1 С, Domienik-Karłowicz J, Tykarski A, et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk: 2021 update. Cardiol J. 2021;28(1):1-14. DOI:10.5603/CJ.a2021.0001Громова М.А., Цурко В.В., Мелехина А.С. Рационально-обоснованный подход к питанию у больных подагрой. Клиницист. 2019;13(3-4):15-21 [Gromova MA, Tsurko VV, Melekhina AS. Rational approach to nutrition for patients with gout. The Clinician. 2019;13(3-4):15-21 (in Russian)]. DOI:10.17650/1818-8338-2019-13-3-4-15-21Yokose C, McCormick N, Choi HK. Dietary and Lifestyle-Centered Approach in Gout Care and Prevention. Curr Rheumatol Rep. 2021;23(7):51. DOI:10.1007/s11926-021-01020-yNielsen SM, Zobbe K, Kristensen LE, Christensen R. Nutritional recommendations for gout: An update from clinical epidemiology. Autoimmun Rev. 2018;17(11):1090-6. DOI:10.1016/j.autrev.2018.05.008Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76:29-42. DOI:10.1136/annrheumdis-2016-209707Sivera F, Andrés M, Carmona L, et al. Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative. Ann Rheum Dis. 2014;73:328-35. DOI:10.1136/annrheumdis-2013-203325Sautner J, Eichbauer-Sturm G, Gruber J, et al. 2022 update of the Austrian Society of Rheumatology and Rehabilitation nutrition and lifestyle recommendations for patients with gout and hyperuricemia. Wien Klin Wochenschr. 2022;134:546-54. DOI:10.1007/s00508-022-02054-7Драпкина О.М., Мазуров В.И., Мартынов А.И., и др. Консенсус для врачей по ведению пациентов с бессимптомной гиперурикемией в общетерапевтической практике. Кардиоваскулярная терапия и профилактика. 2024;23(1):3737 [Drapkina OM, Mazurov VI, Martynov AI, et al. Consensus statement on the management of patients with asymptomatic hyperuricemia in general medical practice. Cardiovascular Therapy and Prevention. 2024;23(1):3737 (in Russian)]. DOI:10.15829/1728-8800-2024-3737Oxford Centre for Evidence-Based Medicine. OCEBM levels of evidence. 2022. Available at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence. Accessed: 03.02.2025.ESC Clinical Practice Guidelines: Policies and Procedures. Available at: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Guidelines-development/Writing-ESC-Guidelines. Accessed: 03.02.2025.Juraschek SP, Miller ER III, Gelber AC. Body mass index, obesity, and prevalent gout in the United States in 1988–1994 and 2007–2010. Arthritis Care Res (Hoboken). 2013;65(1):127-32. DOI:10.1002/acr.21791McCormick N, Rai SK, Lu N, et al. Estimation of primary prevention of gout in men through Modification of obesity and other key lifestyle factors. JAMA NetwOpen. 2020;3(11):e2027421. DOI:10.1001/jamanetworkopen.2020.27421Zhu Y, Zhang Y, Choi HK. The serum urate-lowering impact of weight loss among men with a high cardiovascular risk profile: the multiple risk factor intervention trial. Rheumatology (Oxford). 2010;49(12):2391-9. DOI:10.1093/rheumatology/keq256Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019;16(1):6-31 [Chazova IЕ, Zhernakova YuV ot imeni ekspertov. Diagnosis and treatment of arterial hypertension. Guidelines. Systemic Hypertension. 2019;16(1):6-31 (in Russian)]. DOI:10.26442/2075082X.2019.1.190179Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071. DOI:10.1097/HJH.0000000000003480Diet Review: Mediterranean Diet. Available at: https://nutritionsource.hsph.harvard.edu/healthy-weight/diet-reviews/mediterranean-diet/ Accessed: 03.02.2025.U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute Your Guide to Lowering Your Blood Pressure with DASH. Available at: https://www.nhlbi.nih.gov/files/docs/public/heart/new_dash.pdf. Accessed: 03.02.2025.Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt. B):2960-84. DOI:10.1016/j.jacc.2013.11.003Sotos-Prieto M, Bhupathiraju SN, Mattei J, et al. Association of Changes in Diet Quality with Total and Cause-Specific Mortality. N Engl J Med. 2017;377:143-53. DOI:10.1056/nejmoa1613502Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-41. DOI:10.1056/nejmoa0708681Guasch-Ferré M, Bulló M, Babio N, et al. Mediterranean diet and risk of hyperuricemia in elderly participants at high cardiovascular risk. J Gerontol A Biol Sci Med Sci. 2013;68:1263-70. DOI:10.1093/gerona/glt028Gao Y, Cui LF, Sun YY, et al. Adherence to the dietary approaches to stop hypertension diet and hyperuricemia: a cross-sectional study. Arthritis Care Res (Hoboken). 2021;73(4):603-11. DOI:10.1002/acr.24150Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3-10. DOI:10.1056/NEJM200101043440101Appel LJ, Sacks FM, Carey VJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005;294:2455-64. DOI:10.1001/jama.294.19.2455Belanger MJ, Wee CC, Mukamal KJ, et al. Effects of dietary macronutrients on serum urate: results from the OmniHeart trial. Am J Clin Nutr. 2021;113(6):1593-9. DOI:10.1093/ajcn/nqaa424Tang O, Miller ER 3rd, Gelber AC, et al. DASH diet and change in serum uric acid over time. Clin Rheumatol. 2017;36(6):1413-7. DOI:10.1007/s10067-017-3613-xJuraschek SP, Gelber AC, Choi HK, et al. Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet and Sodium Intake on Serum Uric Acid. Arthritis Rheumatol. 2016;68:3002-9. DOI:10.1002/art.39813Tran E, Dale HF, Jensen C, Lied GA. Effects of Plant-Based Diets on Weight Status: A Systematic Review. Diabetes Metab Syndr Obes. 2020;13:3433-48. DOI:10.2147/dmso.s272802Satija A, Hu FB. Plant-based diets and cardiovascular health. Trends Cardiovasc Med. 2018;28:437-41. DOI:10.1016/j.tcm.2018.02.004Chiu THT, Liu C-H, Chang C-C, et al. Vegetarian diet and risk of gout in two separate prospective cohort studies. Clin Nutr. 2020;39:837-44. DOI:10.1016/j.clnu.2019.03.016Li R, Yu K, Li C. Dietary factors and risk of gout and hyperuricemia: a meta-analysis and systematic review. Asia Pac J Clin Nutr. 2018;27(6):1344-56. DOI:10.6133/apjcn.201811_27(6).0022Zgaga L, Theodoratou E, Kyle J, et al. The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study. PLoS One. 2012;7(6):e38123. DOI:10.1371/journal.pone.0038123Choi HK, Atkinson K, Karlson EW, et al. Alcohol intake and risk of incident gout in men: a prospective study. Lancet. 2004;363(9417):1277-81. DOI:10.1016/s0140-6736(04)16000-5Neogi T, Chen C, Niu J, et al. Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. Am J Med. 2014;127(4):311-8. DOI:10.1016/j.amjmed.2013.12.019Jamnik J, Rehman S, Blanco Mejia S, et al. Fructose intake And risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open. 2016;6(10):e13191. DOI:10.1136/bmjopen-2016-013191Ayoub-Charette S, Liu Q, Khan TA, et al. Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohortstudies. BMJ Open. 2019;9(5):e24171. DOI:10.1136/bmjopen-2018-024171Evans PL, Prior JA, Belcher J, et al. Gender-specific risk factors for gout: a systematic review of cohort studies. Adv Rheumatol. 2019;59(1):24. DOI:10.1186/s42358-019-0067-7Dalbeth N, Ames R, Gamble GD, et al. Effects of skim milk powder enriched with glycomacropeptide and G600 milk fat extract on frequency of gout flares: A proof-of-concept randomised controlled trial. Ann Rheum Dis. 2012;71(6):929-34. DOI:10.1136/annrheumdis-2011-200156Zhang Y, Yang T, Zeng C, et al. Is coffee consumption associated with a lower risk of hyperuricaemia or gout? A systematic review and meta-analysis. BMJ Open. 2016;6(7):e9809 DOI:10.1136/bmjopen-2015-009809corr1Hillman AR, Uhranowsky K. Acute ingestion of Montmorency tart cherry reduces serum uric acid but has no impact on high sensitivity C-reactive protein or oxidative capacity. Plant Foods Hum Nutr. 2021;76(1):83-9. DOI:10.1007/s11130-021-00879-7Lamb KL, Lynn A, Russell J, Barker ME. Effect of tart cherry juice on risk of gout attacks: protocol for a randomized controlled trial. BMJ Open. 2020;10:e35108. DOI:10.1136/bmjopen-2019-035108Стародубова А.В., Чазова И.Е., Тутельян В.А., и др. Евразийские клинические рекомендации по питанию при сердечно-сосудистых заболеваниях (2024). Евразийский кардиологический журнал. 2024;(4):6-66 [Starodubova AV, Chazova IE, Tutelyan VA, et al. Eurasian clinical practice guidelines for dietary management of cardiovascular diseases (2024). Eurasian Heart Journal. 2024;(4):6-66 (in Russian)]. DOI:10.38109/2225-1685-2024-4-6-66Richette P, Clerson P, Perissin L, et al. Revisiting comorbidities in gout: a cluster analysis. Ann Rheum Dis. 2015;74:142-7. DOI:10.1136/annrheumdis-2013-203779Bevis M, Blagojevic-Bucknall M, Mallen C, et al. Comorbidity clusters in people with gout: an observational cohort study with linked medical record review. Rheumatology (Oxford). 2018;57:1358-63. DOI:10.1093/rheumatology/key096Yokose CLL, Chen-Xu M, Zhang Y, Choi HK. Comorbidity Patterns in Gout Using the US General Population – Cluster Analysis of the National Health and Nutrition Examination Survey 2007–2016. Ann Rheum Dis. 2019;78(2):A1294. DOI:10.1093/rheumatology/key096