Résumé
Objective To study the effects of adjusted proportional macronutrient intake on serum uric acid,blood lipids,renal function,and nutritional status of patients with gout and overweight.Methods Sixtyseven patients with gout and overweight were randomized into high protein group and low purine group for 6 months.Each patient had had at least one gouty attacks during the six months before enrollment.Dietary recommendations consisted of calorie restriction to 6276 kJ per day with 40％ derived from carbohydrate,30％ from protein,and 30％ from fat,and the refined carbohydrates were replaced with complex ones and saturated fats with mono-and polyunsaturated ones.High protein group didn't limit purine intake.The two dietary consisted of isoenergetic (6276 kJ).Dietary of low purine group consisted of 60％ derived from carbohydrate,10％ from protein,and 30％ from fat,and limited of parine ＜ 150 mg/d.At onset and 6 months after intervention,fasting blood samples were taken for determination of uric acid(UA),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting plasma glucose(FBG),serum creatinine(SCr),blood urea nitrogen(BUN),albumin(ALB),total protein(TP),and hemoglobin(Hb);the number of gout attacks was recorded.Results Sixty-one persons completed the study.Dietary measures resulted in weight loss[(65.75 ± 3.26)vs(69.31 ± 7.78)kg,P =0.043)and a decrease in the frequency of sixmonth gout attacks(17 vs 28,P =0.000).After the trial,compared to low-purine group,UA[(420.25 ±36.78)vs(466.81 ±41.97)μmol/L,P=0.000],TC[(5.69±0.46)vs(6.49±1.04)mmol/L,P=0.007),TG[(2.15 ±0.54)vs(3.13 ±0.62)mmol/L,P =0.000]and FBG[(5.63 ±0.82)vs(6.49 ±0.64)mmol/L,P =0.000]decreased significantly in the high protein group.There were no significant differences in LDL-C[(3.55 ±0.80)vs(3.73 ±0.72)mmol/L,P =0.445],SCr[(96.63 ± 16.97)vs(94.28 ±13.35)μmol/L,P =0.597],and BUN[(4.89 ± 1.25)vs(4.46 ± 1.21)mmol/L,P =0.208]between two groups.HDL-C[(1.24±0.22)vs(0.89±0.26)mmol/L,P=0.000],ALB[(41.56±5.37)vs(37.08±5.94)mmol/L,P=0.014],TP(72.97 ±5.41)vs(67.27±7.87)g/L,P=0.005],and Hb[(142.86±12.31)vs(114.25 ± 12.98)g/L,P =0.001]increased significantly in the high protein group.Gouty attacks were reduced and decreased by 48.48％ and 22.22％ in high protein group and low purine group,respectively.The differences between the two group was statistically significant(P =0.000)Conclusion Change in proportional macronutrient intake is helpful to reduce body weight and thus is beneficial for lowering UA,improving lipid metabolism and nutritional status,and decreasing the frequency of gout attacks.