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Diet Gout
Diet Gout
by Juhairina
What is Gout?
Hyperuricaemia Genetics
Comorbidities
Origin of Hyperuricemia
Classification of Gout
Pathogenesis
Factors Contributing to the Progression from
Asymptomatic Hyperuricemia to Primary Gout
• Age of the individual and duration of the hyperuricemia
– Gout rarely appears before 20 to 30 years of hyperuricemia
• Genetic predisposition
– In addition to the well-defined X-linked abnormalities of HGPRT,
primary gout follows multifactorial inheritance and runs in families.
• Heavy alcohol consumption
– predisposes to attacks of gouty arthritis.
• Obesity
– increases the risk of asymptomatic gout.
• Certain drugs (e.g., thiazides)
– predispose to the development of gout.
• Lead toxicity
– increases the tendency to develop saturnine gout
Factors that can Precipitate an attack
• Dietary excess
• Trauma
• Surgery
• Excessive ethanol ingestion
• hypouricemic therapy
• Serious medical illnesses
– myocardial infarction and stroke
Clinical Manifestations
The natural history of gout has four stages:
1. Asymptomatic hyperuricemia
2. Acute gouty arthritis
– sudden onset of excruciating joint pain associated with localized hyperemia,
warmth, and exquisite tenderness.
• Constitutional symptoms are uncommon, except possibly mild fever.
• The majority of first attacks are monarticular; 50% occur in the first metatarsophalangeal
joint.
• About 90% of patients experience acute attacks in the following locations (in descending
order of frequency): insteps, ankles, heels, knees, wrists, fingers, and elbows.
3. Intercritical gout
– Gradually there is complete resolution and the patient enters an
asymptomatic intercritical period.
• In the absence of appropriate therapy, the attacks recur at shorter intervals and
frequently become polyarticular.
4. Chronic tophaceous gout
– Eventually, over the span of years, symptoms fail to resolve completely with
the development of disabling chronic tophaceous gout.
Causes of Gout
• Over abundance of uric acid
– Gout is caused by an overabundance of uric acid crystallizing in the
joints, allowing the jagged edges to produce inflammation and pain.
High uric acid levels in the blood signal the first stages of gout.
• Hereditary
– Gout does run in families and is carried on through the genes.
• Fungi
– Fungi contaminate rich, fatty foods and alcohol. They are able to
manufacture uric acid in the bodies of people susceptible to fungal
infections.
• Metabolic illnesses
Causes of Gout
• Diet
– The consumption of proteins, especially meat, rich fatty foods and
alcohol promote uric acid production. Uric acid is a by-product of
protein metabolism in the liver. Gout results from the excess
production of uric acid.
• Stress
– Gout attacks are triggered by stress
• Weight
– Excess weight, high blood fat levels and diabetes increase the
incidence of gout
Symptoms of Gout
• Joint inflammation with acute pain, swelling,
redness and heat.
• An attack of gout can be severely painful and
occurs without warning.
• Main joints affected are the large toe most
often with inflammation.
• Pain in the knee, thumb, and elbow joints.
• May be accompanied by fever and fatigue.
• Alternating chills and fever.
Lab Findings
• The serum uric acid is elevated (> 7.5 mg/dL)
– However, a single uric acid determination is normal in
up to 25% of cases, so it does not exclude gout,
• ESR and white cell count are frequently elevated.
• Identification of sodium urate crystals in joint
fluid or material aspirated from a tophus
establishes the diagnosis.
– The crystals, which may be extracellular or found
within neutrophils, are needle-like and negatively
birefringent when examined by polarized light
microscopy.
Treatment
Treatment of Acute attacks
• The mainstay of treatment: Nonsteroidal anti-inflammatory
drugs (NSAIDs), colchicine, or glucocorticoids.
– In attacks involving one or two joints, intraarticular
glucocorticoid injections may be preferable and effective.
BMR
– 1x24x 63 = 1512 kcal
• Physical Activity: Light
– = 50% x 1512
– =756 kcal
• SDA
– =10% x(1512 +756)
– = 227kcal
• TER
– 1512+ 756+227
– =2495 kcal
• Percentage Distribution:
– 70% CHO
– 10% CHON
– 20% FAT
• CHO =2495x 70% = kcal /4 = 1747 g ~ 437 g
• CHON =2495x 10% = kcal /4 = 250 g ~63 g
• FAT = 2495x 20% = kcal / 9 = 499 g ~55 g
Diet Prescription
TER= 2495kcal, CHO= 437g, CHON= 63g,
FAT= 55g
Food Number of CHO CHON FAT ENERGY
exchanges
Vegetable A 1
Vegetable B 3 9 3 48
Fruit 6 60 240
Milk 2 24 16 20 40
Sugar 2 10 40
Rice 14 322 28 1400
Meat 2 16 4 100
Fat 6 30 270
Total 425 63 54 2098
Dividing a Day’s Exchange
Between Meals and Snacks
Food Breakfast Lunch PM Snack Dinner Midnight
Snack
Vegetable A 1
Vegetable B 1 1
Fruit 2 2 1
Milk 1 1
Sugar 1 1
Rice 4 4 4 2
Meat 2 2 2
Fat 2 2
Translating A Day’s Exchange into
A Day’s Meal
Meal time Food