Rational Pharmacotherapy in Cardiology

Advanced search

Hyperuricemia: Features of the Diet

Full Text:


The association of hyperuricemia (HU) with cardiovascular disease (CVD), diabetes, metabolic syndrome, and kidney disease has been demonstrated in numerous studies. НU is the main pathogenetic factor in the development of gout and is associated with an increase in overall and cardiovascular mortality. НU is included in the list of factors determining cardiovascular risk. According to epidemiological studies, there is a high prevalence of HU in the world and its increase in recent decades. A number of factors have been identified that contribute to the increased risk of НU. Non-modifiable factors include gender, age, genetic factors, and modifiable factors include diet and lifestyle. Nutritional unbalances, increased life expectancy, increased prevalence of obesity, and increased use of drugs (especially diuretics) are seen as contributing factors to the rise in НU. The review was carried out to summarize the available information on the effect of dietary habits, individual foods and nutrients on serum uric acid (SUA) levels and the risk of developing HU. The review presents the results of scientific studies demonstrating the relationship of НU with the consumption of foods rich in purines (offal, red meat, fish, seafood, legumes), alcohol consumption, drinks sweetened with fructose, coffee, dairy products, vegetables and fruits. Diet correction is an important and necessary step in the prevention and treatment of НU. The article reviews the basic principles of dietary management in HU and provides dietary recommendations for patients. For effective prevention and treatment of НU, a mandatory correction of the diet is required.

About the Authors

O. B. Shvabskaia
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Olga B. Shvabskaia.


eLibrary  SPIN  1193-2792

O. V. Izmailova
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Olga V. Izmailova.


eLibrary  SPIN  5597-8420

N. S. Karamnova
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Natalia S. Karamnova.


eLibrary SPIN 2878-3016

O. M. Drapkina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Oxana M. Drapkina.


eLibrary  SPIN  4456-1297


1. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. DOI:10.1093/eurheartj/ehy339.

2. Kobalava ZhD, Konradi AO, Nedogoda SV, et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786 (In Russ.) DOI:10.15829/1560-4071-2020-3-3786.

3. Shalnova SA, Deev AD, Artamonovа GV, et al. Hyperuricemia and its correlates in the Russian population (results of ESSE-RF epidemiological study). Rational Pharmacotherapy in Cardiology. 2014;10(1):153-9 (In Russ.) DOI:10.20996/1819-6446-2014-10-2-153-159.

4. Chen-Xu M, Yokose C, Rai SK, et al. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheum. 2019;71(6):991-9. DOI:10.1002/art.40807.

5. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136-41. DOI:10.1002/art.30520.

6. Arun Kumar UA, Browne LD, Li X, et al. Temporal trends in hyperuricaemia in the Irish health system from 2006-2014: A cohort study. PLoS One. 2018;13(5):e0198197. DOI:10.1371/journal.pone.0198197.

7. Liu R, Han C, Wu D, et al. Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis. Biomed Res Int. 2015;2015:762820. DOI:10.1155/2015/762820.

8. Song P, Wang H, Xia W, et al. Prevalence and correlates of hyperuricemia in the middle-aged and older adults in China. Sci Rep.2018;8(1):4314. DOI:10.1038/s41598-018-22570-9.

9. Stewart DJ, Langlois V, Noone D. Hyperuricemia and Hypertension: Links and Risks. Integr Blood Press Control. 2019;12:43-62. DOI: 10.2147/IBPC.S184685.

10. Nicholls A, Snaith ML, Scott JT. Effect of oestrogen therapy on plasma and urinary levels of uric acid. Br Med J. 1973;1(5851):449-51. DOI:10.1136/bmj.1.5851.449.

11. MacFarlane LA, Kim SC. Gout: a review of non-modifiable and modifiable risk factors. Rheum Dis Clin North Am. 2014;40(4):581-604. DOI:10.1016/j.rdc.2014.07.002.

12. Butler F, Alghubayshi A, Roman Y. The Epidemiology and Genetics of Hyperuricemia and Gout across Major Racial Groups: A Literature Review and Population Genetics Secondary Database Analysis. J Pers Med. 2021;11(3):231. DOI: 10.3390/jpm11030231.

13. Maksimov SA, Shalnova SA, Balanova YA, et al. Hyperuricemia versus lifestyle in men and women of the Russian Federation population. Russian Open Medical Journal. 2020;9:e0214. DOI:10.15275/rusomj.2020.0214.

14. Gout. Clinical guidelines. Association of Rheumatologists of Russia, 2018 [cited 2021 May 01]. Available from: (In Russ.)

15. Yeliseyev MS, Yeliseyeva MYe. Modern Aspects of Pathogenesis and Correction of Hyperuricemia and Associated Conditions. Effective Pharmacotherapy. 2019;15(8):32-40 (In Russ.) DOI:10.33978/2307-3586-2019-15-8-32-40.

16. Maiuolo J, Oppedisano F, Gratteri S, et al. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;8-14. DOI:10.1016/j.ijcard.2015.08.109.

17. Valsaraj R, Kumar S.A, Kumar G.K, et al. Management of asymptomatic hyperuricemia: Integrated Diabetes & Endocrine Academy (IDEA) consensus statement. Diabetes MetabSyndr. 2020;14(2):93-100. DOI:10.1016/j.dsx.2020.01.007.

18. Kuwabara M, Niwa K, Hisatome I, et al. Asymptomatic Hyperuricemia Without Comorbidities Predicts Cardiometabolic Diseases: Five-Year Japanese Cohort Study. Hypertension. 2017;69(6):1036-44. DOI: 10.1161/HYPERTENSIONAHA.116.08998.

19. Piani F, Cicero AFG, Borghi C. Uric Acid and Hypertension: Prognostic Role and Guide for Treatment. J Clin Med. 2021;10(3):448. DOI:10.3390/jcm10030448.

20. Ali N, Perveen R, Rahman S, et al. Prevalence of hyperuricemia and the relationship between serum uric acid and obesity: A study on Bangladeshi adults. PLoS One. 2018;13(11):e0206850. DOI:10.1371/journal.pone.0206850.

21. Han T, Lan L, Qu R, et al. Temporal Relationship Between Hyperuricemia and Insulin Resistance and Its Impact on Future Risk of Hypertension. Hypertension. 2017;70(4):703-11. DOI: 10.1161/HYPERTENSIONAHA.117.09508.

22. Nagahama K, Iseki K, Inoue T, et al. Hyperuricemia and cardiovascular risk factor clustering in a screened cohort in Okinawa, Japan. Hypertens Res. 2004;27(4):227-33. DOI:10.1291/hypres.27.227.

23. Park JH, Jo YI, Lee JH. Renal effects of uric acid: hyperuricemia and hypouricemia. Korean J Intern Med. 2020;35(6):1291-304. DOI:10.3904/kjim.2020.410.

24. Zhang Y, Zhang M, Yu X, et al. Association of hypertension and hypertriglyceridemia on incident hyperuricemia: an 8-year prospective cohort study. J Transl Med. 2020;18(1):409. DOI:10.1186/s12967-020-02590-8.

25. Virdis A, Masi S, Casiglia E, et al. Identification of the Uric Acid Thresholds Predicting an Increased Total and Cardiovascular Mortality Over 20 Years. Hypertension. 2020;75(2):302-8. DOI:10.1161/HYPERTENSIONAHA.119.13643.

26. Otaki Y, Konta T, Ichikawa K, et al. Possible burden of hyperuricaemia on mortality in a community-based population: a large-scale cohort study. Sci Rep. 2021;11(1):8999. DOI:10.1038/s41598-021-88631-8.

27. Zuo T, Liu X, Jiang L, et al. Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies. BMC Cardiovasc Disord. 2016;16(1):207. DOI:10.1186/s12872-016-0379-z.

28. Casiglia E, Tikhonoff V, Virdis A, et al. Serum uric acid and fatal myocardial infarction: detection of prognostic cut-off values: The URRAH (Uric Acid Right for Heart Health) study. J Hypertens. 2020;38(3):412-9. DOI:10.1097/HJH.0000000000002287.

29. Borghi C, Tykarski A, Widecka K, et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk. Cardiol J. 2018;25(5):545-63. DOI:10.5603/CJ.2018.0116.

30. Chazova IE, Zhernakova JV, Kisliak OA, et al. Consensus on patients with hyperuricemia and high cardiovascular risk treatment. Systemic Hypertension. 2019;16(4):8-21 (In Russ.) DOI:10.26442/2075082X.2019.4.190686.

31. Borghi C, 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.a2021.0001.

32. Zykova SN, Storhaug HM, Toft I, et al. Cross-sectional analysis of nutrition and serum uric acid in two Caucasian cohorts: the AusDiab Study and the Tromsø study. Nutr J. 2015;14:49. DOI:10.1186/s12937-015-0032-1.

33. Vedder D, Walrabenstein W, Heslinga M, et al. Dietary Interventions for Gout and Effect on Cardiovascular Risk Factors: A Systematic Review. Nutrients. 2019;11(12):2955. DOI:10.3390/nu11122955.

34. Nielsen SM, Bartels EM, Henriksen M, et al. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis. 2017;76(11):1870-82. DOI:10.1136/annrheumdis-2017-211472.

35. Liu W, Zhang H, Han X, et al. Uric acid level changes after bariatric surgery in obese subjects with type 2 diabetes mellitus. Ann Transl Med. 2019;7(14):332. DOI:10.21037/atm.2019.06.66.

36. Dalbeth N, Chen P, White M, et al. Impact of bariatric surgery on serum urate targets in people with morbid obesity and diabetes: a prospective longitudinal study. Ann Rheum Dis. 2014;73(5):797-802. DOI:10.1136/annrheumdis-2013-203970.

37. Juraschek 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(12):3002-9. DOI:10.1002/art.39813.

38. Stamostergiou J, Theodoridis X, Ganochoriti V, et al. The role of the Mediterranean diet in hyperuricemia and gout. Mediterr J Rheumatol. 2018;29(1):21-5. DOI:10.31138/mjr.29.1.21.

39. Guasch-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(10):1263-70. DOI:10.1093/gerona/glt028.

40. Hafez RM, Abdel-Rahman TM, Naguib RM. Uric acid in plants and microorganisms: Biological applications and genetics - A review. J Adv Res. 2017;8(5):475-86. DOI:10.1016/j.jare.2017.05.003.

41. Kaneko K, Aoyagi Y, Fukuuchi T, et al. Total Purine and Purine Base Content of Common Foodstuffs for Facilitating Nutritional Therapy for Gout and Hyperuricemia. Biol Pharm Bull. 2014;37(5):709-21. DOI:10.1248/bpb.b13-00967.

42. Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005;52(1):283-9. DOI:10.1002/art.20761.

43. Choi HK, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350(11):1093-103. DOI:10.1056/NEJMoa035700.

44. Williams PT. Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men. Am J Clin Nutr. 2008;87(5):1480-7. DOI:10.1093/ajcn/87.5.1480.

45. Kiyohara C, Kono S, Honjo S et al. Inverse association between coffee drinking and serum uric acid concentrations in middle-aged Japanese males. Br J Nutr. 1999;82(2):125-30.

46. Pham N.M, Yoshida D, Morita M, et al. The relation of coffee consumption to serum uric Acid in Japanese men and women aged 49-76 years. J Nutr Metab. 2010;2010:930757. DOI:10.1155/2010/930757.

47. Choi HK, Curhan G. Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey. Arthritis Rheum. 2007;57(5):816-21. DOI:10.1002/art.22762.

48. Choi HK, Willett W, Curhan G. Coffee consumption and risk of incident gout in men: a prospective study. Arthritis Rheum. 2007;56(6):2049-55. DOI:10.1002/art.22712.

49. Zhang 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):e009809. DOI:10.1136/bmjopen-2015-009809.

50. Choi JW, Ford ES, Gao X, Choi H.K. Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2008;59(1):109-16. DOI:10.1002/art.23245.

51. Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008;336:309-12. DOI:10.1136/bmj.39449.819271.BE.

52. Choi HK, Willett W, Curhan G. Fructose-rich beverages and risk of gout in women. JAMA. 2010;304(20):2270-278. DOI:10.1001/jama.2010.1638.

53. Zgaga L, Theodoratou E, KyleJ, 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.0038123.

54. Nakagawa T, Lanaspa MA, Johnson RJ. The effects of fruit consumption in patients with hyperuricaemia or gout. Rheumatology (Oxford). 2019;58(7):1133-41. DOI:10.1093/rheumatology/kez128.

55. Kanbara A, Hakoda M, Seyama I. Urine alkalization facilitates uric acid excretion. Nutr J. 2010;9:45. DOI:10.1186/1475-2891-9-45.

56. Kanbara A, Miura Y, Hyogo H, et al. Effect of urine pH changed by dietary intervention on uric acid clearance mechanism of pH-dependent excretion of urinary uric acid. Nutr J. 2012;11:39. DOI:10.1186/1475-2891-11-39.

57. Brzezińska O, Styrzyński F, Makowska J, Walczak K. Role of Vitamin C in Prophylaxis and Treatment of Gout-A Literature Review. Nutrients. 2021;13(2):701. DOI:10.3390/nu13020701.

58. Collins MW, Saag KG, Singh J.A. Is there a role for cherries in the management of gout? Ther Adv Musculoskelet Dis. 2019;11. DOI:10.1177/1759720X19847018.

59. Chen PE, Liu CY, Chien WH, et. Effectiveness of Cherries in Reducing Uric Acid and Gout: A Systematic Review. Evid Based Complement Alternat Med. 2019;2019:9896757. DOI:10.1155/2019/9896757.

60. Teng GG, Pan A, Yuan JM, Koh WP. Food Sources of Protein and Risk of Incident Gout in the Singapore Chinese Health Study. Arthritis Rheumatol. 2015;67(7):1933-42. DOI:10.1002/art.39115.

61. Garrel DR, Verdy M, PetitClerc C, et al. Milk- and soy-protein ingestion: acute effect on serum uric acid concentration. Am J Clin Nutr. 1991;53(3):665-9. DOI:10.1093/ajcn/53.3.665.

62. Brulé D, Sarwar G, Savoie L. Changes in serum and urinary uric acid levels in normal human subjects fed purine-rich foods containing different amounts of adenine and hypoxanthine. J Am Coll Nutr. 1992;11(3):353-8. DOI:10.1080/07315724.1992.10718238.

63. Dalbeth N, Horne A, Gamble GD, et al. The effect of calcium supplementation on serum urate: analysis of a randomized controlled trial. Rheumatology (Oxford). 2009;48(2):195-7. DOI:10.1093/rheumatology/ken416.

64. Dalbeth N, Wong S, Gamble GD, et al. Acute effect of milk on serum urate concentrations: a randomised controlled crossover trial. Ann Rheum Dis. 2010;69(9):1677-82. DOI:10.1136/ard.2009.124230.

65. Choi 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)16000-5.

66. Choi HK, Curhan G. Beer, liquor, and wine consumption and serum uric acid level: The Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2004;51(6):1023-9. DOI:10.1002/art.20821.

67. Nakamuraa K, Sakuraia M, Miura K, et al. Alcohol intake and the risk of hyperuricaemia: A 6-year prospective study in Japanese men. Nutr Metab Cardiovasc Dis. 2012;22(11):989-96. DOI:10.1016/j.numecd.2011.01.003.

68. Gapparova KM, Sharafetdinov KhKh. Diet for gout. In: Tutel'yan VA, Nikitiuk DB, eds. Nutritional science and clinical nutrition. National guidelines. Moscow: GOETAR-Media; 2020. p.482-6 (In Russ.)

69. Juraschek SP, McAdams-Demarco M, Gelber AC, et al. Effects of Lowering Glycemic Index of Dietary Carbohydrate on Plasma Uric Acid Levels: The OmniCarb Randomized Clinical Trial. Arthritis Rheum. 2016;68(5):1281-9. DOI:10.1002/art.39527.


For citation:

Shvabskaia O.B., Izmailova O.V., Karamnova N.S., Drapkina O.M. Hyperuricemia: Features of the Diet. Rational Pharmacotherapy in Cardiology. 2021;17(6):889-899. (In Russ.)

Views: 70

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)