Hyperuricemia is a metabolic disorder caused by a disorder of purine metabolism. Under normal diet, the fasting blood uric acid level > 420 μmol/L measured twice on the same day can be diagnosed as hyperuricemia. Gout is a metabolic disease characterized by hyperuricemia and precipitation and tissue deposition of urate crystals, leading to inflammation and tissue damage. Hyperuricemia and gout are independent risk factors for chronic kidney disease, hypertension, cardiovascular and cerebrovascular diseases, and diabetes.
On February 8, 2024, the General Office of the National Health Commission issued the "Guidelines for Dietary Nutrition of Adults with Hyperuricemia and Gout (2024 Edition)", which provides scientific guidance for the prevention and control of the occurrence and development of hyperuricemia and gout in mainland China, the improvement of the daily diet of hyperuricemia and gout, the improvement of residents' nutritional health, and the development of traditional dietary services.
7 principles of diet for patients with hyperuricemia/gout
The 2024 version of the Guidelines puts forward 7 principles and recommendations for the daily diet of adults with hyperuricemia and gout:
1. Eat a variety of foods and limit purines. 2. Sufficient vegetable milk and limit fructose. 3. Drink plenty of water and limit alcohol consumption. 4. Scientific cooking, less raw and cold. 5. Eat balanced and have a healthy weight. 6. Differentiation of syndromes and bodies, and feeding according to the person. 7. Choose the right meal according to the place and time.
In general, it is recommended that people with hyperuricemia and gout should adhere to the dietary concept of diverse food and balanced nutrition.
4 "Eat", 4 "Don't Eat"
1. Fruits and vegetables
Ensure the intake of cereals and potatoes, vegetables and fruits, livestock, poultry, fish, eggs and milk, soybeans and nuts every day, and no less than 12 kinds of food varieties per day and no less than 25 kinds per week. Eat more fresh vegetables every day, it is recommended to consume at least 500g per day, and dark vegetables (such as purple cabbage, carrots) should account for more than half.
2. Dairy products
Milk protein is an important source of high-quality protein, which can promote uric acid excretion and encourage the daily intake of more than 300mL or equivalent of milk and dairy products.
3. Drink water
Drinking water regularly and regularly can promote uric acid excretion. People with hyperuricemia and gout should drink enough water under normal heart and kidney function, and it is recommended to drink 2000~3000mL per day. Try to maintain a urine output greater than 2000 mL per day.
Priority should be given to plain water, lemon water, weak tea, sugar-free coffee and soda, but excessive consumption of strong tea, strong coffee, etc., should be avoided, and raw and cold drinks should be avoided.
4. Eat balance
Overweight and obesity increase the risk of gout in people with hyperuricemia, and weight loss can significantly reduce blood uric acid levels. Overweight and obese people with hyperuricemia and gout should improve their dietary structure and increase regular exercise to achieve less energy intake than energy consumption on the basis of meeting their daily essential nutritional needs, and at the same time, avoid excessive dieting and weight loss too fast, and reduce 0.5~1.0kg per week to finally control their weight within a healthy range.
5. Limit fructose
Fructose can induce metabolic abnormalities and cause insulin resistance, which has the potential to induce an increase in uric acid levels, and foods with high fructose content should be restricted, such as sugary drinks, freshly squeezed fruit juices, fructose syrup, preserved fruit preserves, etc.
6. Limit alcohol consumption
Drinking alcohol increases the risk of hyperuricemia and gout. Alcohol metabolism affects the release of purines and promotes increased uric acid production, and alcohol also leads to an increase in serum lactate, which reduces uric acid excretion.
Some alcoholic beverages also contain purines, and usually rice wine has a higher purine content, followed by beer. Although the purine content of liquor is low, the alcohol content of liquor is high, which is easy to accumulate lactic acid in the body and inhibit uric acid excretion.
Therefore, alcohol consumption should be limited, and patients with acute gout attacks, poorly controlled medications, or chronic gouty arthritis should refrain from alcohol.
7. Eat less raw and cold
For people with hyperuricemia and gout, regular consumption of raw and cold foods such as ice cream and raw and cold seafood can easily damage the function of the spleen and stomach, and at the same time, it can lead to an increase in the precipitation of urate crystals and induce gout attacks. Therefore, patients with gout should eat less raw and cold foods.
In addition, reasonable food cooking and processing methods are of great significance for the prevention and control of hyperuricemia and gout. Less salt and less oil, less condiments, and a bland diet can help control or lower blood uric acid levels. It is recommended that the daily salt intake should not exceed 5g, and the cooking oil should not exceed 25~30g per day.
Reduce cooking methods such as frying, frying, and marinating, and advocate eating meat after boiling, and try not to drink soup. Cured, cured or smoked meat has high purine and salt content, and people with hyperuricemia and gout should not eat it.
8. Limit purines
People with hyperuricemia and gout should adhere to a low-purine diet and strictly control the purine content in the diet.
Purines in food can be metabolized by the body to produce uric acid. High purine intake increases uric acid production, which can easily cause hyperuricemia. Limiting the intake of high-purine foods can help control blood uric acid levels and reduce the occurrence of gout. The purine content and absorption and utilization rate of different ingredients are different, and people with hyperuricemia and gout should choose ingredients scientifically, mainly with low-purine diets, and strictly control the purine content in the diet.
Animal offal, such as liver, kidney, heart, etc., the purine content is generally higher than that of ordinary meat, and the choice should be avoided as much as possible. Eggs are low in purines such as egg white and milk, so they can be eaten safely. Although the purine content of soybeans is slightly higher than that of lean meat and fish, the purine utilization rate in plant foods is low, and the purine content of soy products such as tofu and dried tofu is reduced after processing, so it can be eaten in moderation.
It is advisable to choose carbohydrate foods with low glycemic production index, with whole grain foods not less than 30% of the amount of staple foods per day, and dietary fiber intake reaching 25~30g. In addition, each individual reacts differently to food, and people with a history of gout attacks should try to avoid eating foods that have triggered gout attacks in the past on the basis of following the above principles.
List of purine levels in common foods
Table 1 Classification of common foods by purine content (unit: mg/100g)
Literature link: https://guide.medlive.cn/guideline/31037
Shingen
National Health Commission of the People's Republic of China. Dietary Guidelines for Adults with Hyperuricemia and Gout (2024 Edition). Official website of the National Health Commission of the People's Republic of China.2024.
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