Impact of Cardiovascular and Weight Loss diets on Uric Acid and Gout Risk

心血管和减肥饮食对尿酸和痛风风险的影响

基本信息

批准号：
8631343
负责人：
HYON K CHOI
金额：
$ 37.94万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-20 至 2017-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8631343
关键词：
Address Adult American Atkins Diet Behavior Therapy Blood specimen Body Weight decreased Carbohydrates Cardiovascular system Cessation of life Clinical Trials Design Comorbidity Consumption DASH diet Data Data Quality Diet Diet Modification Dietary Practices Excretory function Fat-Restricted Diet Fatty acid glycerol esters Food Future Glucose Goals Gout Health Professional Hypertension Hyperuricemia Incidence Individual Insulin Resistance LDL Cholesterol Lipoproteins Life Style Macronutrients Nutrition Measures Mediating Mediterranean Diet Metabolic Morbidity - disease rate Myocardial Infarction National Health and Nutrition Examination Survey Nurses&apos Health Study Obesity Outcome Pain Plant Sources Plasma Positioning Attribute Prevalence Prevention Research Prevention strategy Proteins Purines Randomized Controlled Trials Research Research Design Rheumatoid Arthritis Risk Sampling Serum Sodium Testing Triglycerides Urate Uric Acid Validation Variant Weight Woman arthropathies base burden of illness cardiovascular risk factor cohort cost effective experience follow-up ketogenesis low density lipoprotein triglyceride men monounsaturated fat mortality premature prospective public health relevance purine saturated fat woman health professional young woman

项目摘要

Gout is a common and excruciatingly painful inflammatory arthritis associated with hyperuricemia. Gout represents a metabolically-driven arthropathy that could be substantially controlled through dietary and lifestyle modifications. With the continued "western" lifestyle in the US, the prevalence and incidence of gout have increased over the last few decades and it is estimated that 3.9% of US adults (8.3 million individuals) have had gout according to the latest US NHANES data. This remarkable burden of gout is further complicated by its high level of cardiovascular (CV)-metabolic comorbidities (e.g., hypertension in 74% and obesity in 53% of cases) and their consequences (e.g., increased future risk of myocardial infarction and premature death). The current low-purine dietary approach to gout offers limited efficacy, palatability, and sustainability, and promotes increased consumption of refined carbohydrates and saturated fat that can actually worsen gout's CV-metabolic comorbidities by leading to insulin-resistance and increased levels of plasma glucose, triglycerides, and LDL-cholesterol. Therefore, there is an urgent need for a unifying, sustainable, and effective prevention strategy that holistically addresses both gout and its associated comorbidities. In fact, there are proven, effective dietary approaches to reduce CV-metabolic conditions (including obesity) that could also lower serum uric acid (SUA) levels and the risk of gout by lowering adiposity and insulin resistance. These existing approaches could potentially provide an ideal dietary strategy to reduce both the risk of gout and its associated CV-metabolic conditions. In this study, we will build upon our extensive experience with gout prevention research to examine the impact of these dietary approaches on the outcomes of both SUA and gout. We will investigate their effects on SUA levels using stored blood samples from 6 landmark randomized controlled trials of various dietary approaches to reduce CV-metabolic conditions (including the Mediterranean, Atkins, and DASH diets) (Aims 1-3). Through participation of the PIs of all 6 trials in this project, we will take full advantage of the original RCT designs and collected data. Further, we will evaluate their impact on the risk of gout based on 3 large prospective cohorts: the Nurses' Health Study (NHS) I (n=121,700 women), NHS II (n=116,430 younger women), and the Health Professionals Follow-up Study (HPFS; n=51,529 men) (Aim 4). We will take advantage of systematically collected high- quality data that have undergone rigorous validation including >3,200 confirmed cases of incident gout. These aims hold the potential to revolutionize our non-pharmacological urate-lowering approaches to hyperuricemia and gout by simultaneously investigating multiple candidate diets using a highly cost-effective study design. These measures will also comprehensibly address the major comorbidities associated with the rising disease burden of gout. With our extensive gout research experience combined with resourceful data access, we are in a unique and unparalleled position to address these key issues facing the field in the US and beyond.

痛风是一种常见且极其疼痛的炎症性关节炎，与高尿酸血症相关。痛风代表一种代谢驱动的关节病，可以通过饮食和生活方式得到基本上控制修改。随着美国“西式”生活方式的持续，痛风的患病率和发病率已呈上升趋势。过去几十年来有所增加，据估计 3.9% 的美国成年人（830 万人）根据美国 NHANES 最新数据，患有痛风。痛风的这种显着负担更加复杂其心血管 (CV) 代谢合并症水平较高（例如，74% 的人患有高血压，20% 的人患有肥胖症） 53% 的病例）及其后果（例如，未来发生心肌梗塞和过早死亡的风险增加）死亡）。目前治疗痛风的低嘌呤饮食方法的功效、适口性和可口性有限。可持续性，并促进精制碳水化合物和饱和脂肪的消费增加，实际上会导致胰岛素抵抗和胰岛素水平升高，从而恶化痛风的心血管代谢合并症血浆葡萄糖、甘油三酯和低密度脂蛋白胆固醇。因此，迫切需要一个统一的、可持续、有效的预防战略，全面解决痛风及其相关问题合并症。事实上，有一些行之有效的饮食方法可以减少心血管代谢状况（包括肥胖），还可以通过降低血清尿酸（SUA）水平和痛风风险肥胖和胰岛素抵抗。这些现有方法可能提供理想的饮食策略降低痛风及其相关心血管代谢状况的风险。在这项研究中，我们将基于我们的在痛风预防研究方面拥有丰富的经验，以检查这些饮食方法对痛风的影响 SUA 和痛风的结果。我们将使用储存的血液样本研究它们对 SUA 水平的影响来自 6 项具有里程碑意义的随机对照试验，这些试验涉及各种减少心血管代谢的饮食方法条件（包括地中海饮食、阿特金斯饮食和 DASH 饮食）（目标 1-3）。通过参与本项目所有6项试验的PI，我们将充分利用原始RCT设计和收集的数据。此外，我们将根据 3 个大型前瞻性队列评估它们对痛风风险的影响：护士的健康研究 (NHS) I（n=121,700 名女性）、NHS II（n=116,430 名年轻女性）和健康专业人员后续研究（HPFS；n=51,529 名男性）（目标 4）。我们将利用系统收集的高经过严格验证的质量数据，包括超过 3,200 例确诊的痛风病例。这些目标有可能彻底改变我们治疗高尿酸血症的非药物降尿酸方法通过一项极具成本效益的研究同时调查多种候选饮食来治疗痛风设计。这些措施还将全面解决与不断上升的患者相关的主要合并症。痛风的疾病负担。凭借我们丰富的痛风研究经验以及丰富的数据访问，我们处于独特且无与伦比的地位来解决美国及其他地区该领域面临的这些关键问题。