Nutrición e hiperuricemia

  • Estrella Menéndez E. Servicio de Nutrición, CEMIC, Buenos Aires
  • Cristina Milano Fresenius Medical Care, Buenos Aires
  • Florencia Alassia Sanofi, Buenos Aires
  • Roxana Carreras Departamento de Alimentación, Hospital Nacional Posadas, Buenos Aires
  • Marcela Casonú Servicio de Nutrición, Hospital Alemán, Buenos Aires
  • Myriam Cipres Fresenius Medical Care, Buenos Aires
  • Yanina Maccio Servicio de Nefrología, Hemodiálisis y Diálisis Peritoneal, Centro Integral de Medicina de Alta Complejidad (CIMAC), San Juan
  • Lorena Mañez División de Alimentación, Hospital General de Agudos José María Ramos Mejía, Buenos Aires
  • Mariela Volta Centro de Estudio de Enfermedades Renales e Hipertensión Arterial (CEREHA), Buenos Aires
  • Alicia Ester Elbert Centro de Estudio de Enfermedades Renales e Hipertensión Arterial (CEREHA), Buenos Aires

Resumen

El aumento de la incidencia y prevalencia de hiperuricemia asintomática, la que está fuertemente asociada a los factores de riesgo cardiovasculares clásicos y la dificultad para definir su tratamiento con drogas ha jerarquizado al tratamiento dietético, a los efectos de identificar los alimentos que pueden tener efectos protectores sobre el nivel de ácido úrico plasmático (AU). Los niveles del AU dependen de la producción endógena (10%), disminución de la excreción (90%) o de ambas. La producción del AU depende de la ingesta de purina, sin embargo, una dieta rica en purina sería responsable solo de un aumento en 1 a 2 mg / dl del AU sérico. La pérdida < 5 kg disminuye hasta un 45% el riesgo de aumentar el AU, mientras que pérdidas superiores reducirían al menos el 60% del riesgo. De igual manera, el descenso del peso máximo y la estabilidad del peso disminuyen el riesgo de hiperuricemia. Se sugiere que este descenso no sea brusco para evitar el catabolismo muscular que puede conducir a sarcopenia con pérdida de la fuerza y debilidad muscular y aumento concomitante del AU. Reducen los niveles séricos de AU: leche, yogur y quesos blancos, las frutas ricas en vitamina C, huevos, frutas secas sin sal, legumbres (incluidas la soja) y pollo, salmón, bacalao y langosta. Debe limitarse las carnes rojas (cerdo, ternera, cabrito), y evitarse mariscos, pescados (trucha, atún, palometa, vieiras, anchoa, arenque, sardinas y atún en aceite), tocino, vísceras, pavo, cordero.

Citas

de Oliveira EP, Burini RC. High plasma uric acid concentration: causes and consequences. Diabetol Metab Syndr. 2012;4:12.

Schlesinger N. Dietary factors and hyperuricaemia. Curr Pharm Des. 2005;11(32):4133-8.

Roddy E. Hyperuricemia, gout, and lifestyle factors. J Rheumatol. 2008;35(9):1689-91.

Levy G, Cheetham TC. Is It Time to Start Treating Asymptomatic Hyperuricemia? Am J Kidney Dis. 2015;66(6):933-5.

Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout. Curr Opin Rheumatol 2010;22(2):165-72.

Zgaga L, Theodoratou E, Kyle J, Farrington S, Agakov F, Tenesa A, 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.

You L, Liu A, Wuyun G, Wu H, Wang P. Prevalence of hyperuricemia and the relationship between serum uric acid and metabolic syndrome in the Asian Mongolian area. J Atheroscler Thromb. 2014;21(4):355-65.

Ruggiero C, Cherubini A, Guralnik J, Semba RD, Maggio M, Ling SM, Lauretani F, Bandinelli S, Senin U, Ferrucci L.et al. The interplay between

uric acid and antioxidants in relation to physical function in older persons. J Am Geriatr Soc. 2007;55(8):1206-15.

Huang C, Niu K, Kobayashi Y, Guan L, Momma H, Cui Y, et al. An inverted J-shaped association of serum uric acid with muscle strength among Japanese adult men: a cross-sectional study. BMC Musculoskelet Disord. 2013;14:258.

Beavers KM, Beavers DP, Serra MC, Bowden RG, Wilson RL. Low relative skeletal muscle mass indicative of sarcopenia is associated with elevations in serum uric acid levels: findings from NHANES III. J Nutr Health Aging. 2009;13(3):177-82.

Dessein PH, Shipton EA, Stanwix AE, JoVe BI, Ramokgadi J. Beneficial eVects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000;59:539-43.

Gao B, Zhou J, Ge J, Zhang Y, Chen F, Lau WB, et al. Association of maximum weight with hyperuricemia risk: a retrospective study of 21,414 Chinese people. PLoS One. 2012;7(11):e51186.

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.

Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350(11):1093-103.

Wang H, Cao G, Prior R. Total antioxidant capacity of fruits. J Agric Food Chem. 1996;44(3):701-5.

Choi HK, Curhan G. Gout: epidemiology and lifestyle choices. Curr Opin Rheumatol. 2005;17(3):341-5.

Lyu LC, Hsu CY, Yeh CY, Lee MS, Huang SH, Chen CL. A case-control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr. 2003;78(4):690-701.

Jacob RA, Spinozzi GM, Simon VA, Kelley DS, Prior RL, Hess-Pierce B, et al. Consumption of cherries lowers plasma urate in healthy women. J Nutr. 2003;133(6):1826-9.

Argentina. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica. Código Alimentario Argentino [Internet]. Capítulo X Azúcares, Artículo 778ter. Disponible en: <http://www.anmat.gov.ar/alimentos/codigoa/Capitulo X.pdf> [Consulta: 22/08/2016].

Nakagawa T, Tuttle KR, Short RA, Johnson RJ. Hypothesis: fructose-induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome. Nat Clin Pract Nephrol. 2005;1(2):80-6.

Johnson RJ, Perez-Pozo SE, Sautin YY, Manitius J, Sanchez-Lozada LG, Feig DI, et al. Hypothesis: could excessive fructose intake and uric acid cause type 2 diabetes? Endocr Rev. 2009;30(1):96-116.

Bjornstad P, Lanaspa MA, Ishimoto T, Kosugi T, Kume S, Jalal D, et al. Fructose and uric acid in diabetic nephropathy. Diabetologia. 2015;58(9):1993-2002.

Choi JW, Ford ES, Gao X, Choi HK. 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.

Wrolstad RE, Shallenberger RS. Free sugars and sorbitol in fruits--a complication from the literature. J Assoc Off Anal Chem. 1981;64(1):91-103.

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.

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.

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.

Kela U, Vijayvargiya R, Trivedi CP. Inhibitory effects of methylxanthines on the activity of xanthine oxidase. Life Sci. 1980;27(22):2109-19.

Pacher P, Nivorozhkin A, Szabó C. Therapeutic effects of xanthine oxidase inhibitors: renaissance half a century after the discovery of allopurinol. Pharmacol Rev. 2006;58(1):87-114.

Dulloo AG, Geissler CA, Horton T, Collins A, Miller DS. Normal caffeine consumption: influence on thermogenesis and daily energy expenditure in lean and postobese human volunteers. Am J Clin Nutr. 1989;49(1):44-50.

Astrup A, Toubro S, Cannon S, Hein P, Breum L, Madsen J. Caffeine: a double-blind, placebo-controlled study of its thermogenic, metabolic, and cardiovascular effects in healthy volunteers. Am J Clin Nutr. 1990;51(5):759-67.

Bracco D, Ferrarra JM, Arnaud MJ, Jéquier E, Schutz Y. Effects of caffeine on energy metabolism, heart rate, and methylxanthine metabolism in lean and obese women. Am J Physiol. 1995;269(4 Pt 1):E671-8.

Svilaas A, Sakhi AK, Andersen LF, Svilaas T, Ström EC, Jacobs DR Jr, et al. Intakes of antioxidants in coffee, wine, and vegetables are correlated with plasma carotenoids in humans. J Nutr. 2004;134(3):562-7.

Wu T, Willett WC, Hankinson SE, Giovannucci E. Caffeinated coffee, decaffeinated coffee, and caffeine in relation to plasma C-peptide levels, a marker of insulin secretion, in U.S. women. Diabetes Care. 2005;28(6):1390-6.

Clifford MN. Chlorogenic acids and other cinnamates: nature, occurrence, dietary burden, absorption and metabolism. J Sci Food Agric. 2000;80(7):1033-43.

Chuang SY, Lee SC, Hsieh YT, Pan WH. Trends in hyperuricemia and gout prevalence: Nutrition and Health Survey in Taiwan from 1993-1996 to 2005-2008. Asia Pac J Clin Nutr. 2011;20(2):301-8.

Pham NM, Yoshida D, Morita M, Yin G, Toyomura K, Ohnaka K, 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. pii: 930757.

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

Lanaspa MA, Tapia E, Soto V, Sautin Y, Sánchez-Lozada LG. Uric acid and fructose: potential biological mechanisms. Semin Nephrol. 2011;31(5):426-32.

Barros MP, Ganini D, Lorenço-Lima L, Soares CO, Pereira B, Bechara EJ, et al. Effects of acute creatine supplementation on iron homeostasis and uric acidbased antioxidant capacity of plasma after wingate test. J Int Soc Sports Nutr. 2012;9(1):25.

Guyton JR, Bays HE. Safety considerations with niacin therapy. Am J Cardiol. 2007;99(6A):22C-31C.

Huang HY, Appel LJ, Choi MJ, Gelber AC, Charleston J, Norkus EP, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum. 2005;52(6):1843-7.

Peng H, Li H, Li CH, Chao X, Zhang Q, Zhang Y. Association between Vitamin D Insufficiency and Elevated Serum Uric Acid among Middle-Aged and Elderly Chinese Han Women. PLoS One. 2013;8(4):e61159.

Farag MAM. Effect of different cooking methods on nucleic acid nitrogen bases content of fresh sardine fish and its nutritive value. World J Dairy Food Sci. 2013;8(2):156-64.

Lou SN, Lin CD, Benkmann R. Changes in purine content of Tilapia mossambica during storage, heating and(drying. Food Sci Agric Chem. 2001;3(1):23-9.

Publicado
2016-12-01
Cómo citar
1.
Menéndez E. E, Milano C, Alassia F, Carreras R, Casonú M, Cipres M, Maccio Y, Mañez L, Volta M, Elbert AE. Nutrición e hiperuricemia. Rev Nefrol Dial Traspl. [Internet]. 1 de diciembre de 2016 [citado 28 de marzo de 2024];36(4):246-52. Disponible en: http://revistarenal.org.ar/index.php/rndt/article/view/95
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