Additional mechanisms include increases in energy requirement because of inflammation (see the RA section) and relationships of obesity with gout and OA (see the gout and OA sections).
TABLE 91.1 ARTHRITIS DRUG-NUTRIENT INTERACTIONS
had gout in the previous year, and that 6.1 million adults in the United States had previously had gout (40). The prevalence of gout is increasing in the United States and around the world (34, 36, 41, 42). Gout is much more frequent in men than in women; however, because of greater longevity, gout will become an increasing problem in women (36, 39, 42, 43).
with lower uric acid (60). At intake higher than 400 to 500 mg/day of vitamin C, serum uric acid concentrations plateaued (54, 61). The risk of gout was prospectively evaluated over a 23-year period in 47,150 men who had no history of gout at baseline (56). Increased risk of gout was positively associated with higher consumption of meat and inversely associated with higher intake of dairy products. There were no relationships with intakes of total protein or purine-rich vegetables.
of fluid/day, at least half as water; (b) abstain from alcohol; (c) limit animal foods; (d) eat a moderate amount of protein with recommended sources as low-fat or nonfat dairy, tofu, eggs, and nut butters; and (e) limit meat, fish, and poultry to 4 to 6 ounces/day. During remission from a gout flare, the recommendations are as follows: (a) consume 8 to 16 cups of fluid/day, at least half as water; (b) abstain from alcohol; (c) follow a well-balanced eating plan following the Dietary Guidelines for Americans and, as tolerated, consume animal foods and continue to eat a moderate amount of protein; and (d) maintain a desirable body weight and avoid fasting or high-protein diets for weight loss (69). Choi (67) recommend the following guidelines for patients with gout: (a) exercise daily and reduce weight; (b) limit red meat intake; (c) tailor seafood intake to individual risk for cardiovascular disease and consider omega-3 fatty acid supplements; (d) drink skim milk or consume other low-fat dairy products daily up to 2 servings per day; (e) consume vegetable protein, nuts, legumes, and purine-rich vegetables; (f) reduce alcoholic beverages to less than 1 or 2 drinks per day for men or 1 drink for women; (g) limit sugar-sweetened softdrinks and other beverages containing high-fructose corn syrup; (h) allow coffee drinking if already drinking coffee; and (i) consider taking vitamin C supplements.