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...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-02-01
|
| Series: | Nutrients |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6643/13/2/538 |
| _version_ | 1797413333374074880 |
|---|---|
| author | Stephen P. Juraschek Edgar R. Miller Beiwen Wu Karen White Jeanne Charleston Allan C. Gelber Sharan K. Rai Kathryn A. Carson Lawrence J. Appel Hyon K. Choi |
| author_facet | Stephen P. Juraschek Edgar R. Miller Beiwen Wu Karen White Jeanne Charleston Allan C. Gelber Sharan K. Rai Kathryn A. Carson Lawrence J. Appel Hyon K. Choi |
| author_sort | Stephen P. Juraschek |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-09T05:17:19Z |
| format | Article |
| id | doaj.art-92b9afd867f7417099e323710068e9c4 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-09T05:17:19Z |
| publishDate | 2021-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-92b9afd867f7417099e323710068e9c42023-12-03T12:44:46ZengMDPI AGNutrients2072-66432021-02-0113253810.3390/nu13020538A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with GoutStephen P. Juraschek0Edgar R. Miller1Beiwen Wu2Karen White3Jeanne Charleston4Allan C. Gelber5Sharan K. Rai6Kathryn A. Carson7Lawrence J. Appel8Hyon K. Choi9Beth Israel Deaconess Medical Center, General Medicine, Boston, MA 02215, USAJohns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USAJohns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USAJohns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USAJohns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USAJohns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USADepartment of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USAJohns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USAJohns Hopkins Bloomberg School of Public Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USADivision of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USAThe 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.https://www.mdpi.com/2072-6643/13/2/538dietserum urategouthypertension |
| spellingShingle | Stephen P. Juraschek Edgar R. Miller Beiwen Wu Karen White Jeanne Charleston Allan C. Gelber Sharan K. Rai Kathryn A. Carson Lawrence J. Appel Hyon K. Choi A Randomized Pilot Study of DASH Patterned Groceries on Serum Urate in Individuals with Gout Nutrients diet serum urate gout hypertension |
| 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 | diet serum urate gout hypertension |
| url | https://www.mdpi.com/2072-6643/13/2/538 |
| work_keys_str_mv | AT stephenpjuraschek arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT edgarrmiller arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT beiwenwu arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT karenwhite arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT jeannecharleston arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT allancgelber arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT sharankrai arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT kathrynacarson arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT lawrencejappel arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT hyonkchoi arandomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT stephenpjuraschek randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT edgarrmiller randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT beiwenwu randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT karenwhite randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT jeannecharleston randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT allancgelber randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT sharankrai randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT kathrynacarson randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT lawrencejappel randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout AT hyonkchoi randomizedpilotstudyofdashpatternedgroceriesonserumurateinindividualswithgout |