7万中国人研究揭示：食用豆类与尿酸升高有关，但吃肉不影响！

2022-06-22 四五七 MedSci原创

梅斯头条

企业/

Arthritis Care & Research：较高的得舒饮食模式评分与高尿酸血症风险下降30%有关；豆类食物摄入与高尿酸血症风险增加有关，而肉类摄入与高尿酸血症发生的关联竟然不大。

只有经历过痛风的人才知道痛风发作起来，就像是电钻钻关节，并且随着脉搏跳一次、钻一次，让人恨不得砍断腿or拇指。

一旦得上痛风，就是终身患病，如果病情控制不佳，尿酸盐结晶沉积在患者的骨和肾脏，还会导致关节破坏和肾功能损害。

痛风与高尿酸血症密切相关，在我国，痛风患病率达到1%-3%，而高尿酸血症的患病率则高达13.9%，患病人数超过1.7亿。

2016年中国痛风诊疗指南指出，饮食管理为痛风非药物治疗的核心，通过饮食控制管理可是人体血尿酸水平下降10%-18%。

大部分人都知道高嘌呤食物如动物内脏、海鲜会引起血尿酸水平升高，然而人的饮食是复杂的，比起限制某一食物摄入，不妨通过调控整体的饮食模式来控制饮食中的嘌呤总量。

2017年发表在BMJ的一项随访26年、涵盖4万人的前瞻性研究表明，较高的得舒饮食模式评分与痛风风险降低32%有关，就是说，饮食模式越偏向得舒饮食，痛风风险越低。

*得舒饮食（the Dietary Approaches to Stop Hypertension），是1997年美国一项大型高血压防治计划发展出来的饮食模式，得舒饮食的原则为：①摄入足量的蔬菜、水果和低脂奶制品；②减少饱和脂肪、胆固醇和反式脂肪含量较多食物的摄入；③摄入适量的全谷物、鱼、禽肉和干果类；④控制钠、甜点、含糖饮料和红肉的摄入。

但这是从西方人身上得到的结论，考虑到中西方人种、饮食习惯不同，这一结论适不适用于中国人还是一个问题。

基于此，来自复旦大学的高翔教授联合开滦总医院吴寿岭教授等在中国人群中开展研究，同样发现较高的得舒饮食模式评分与高尿酸血症风险下降30%有关，更有趣的是，在本研究中，豆类食物摄入与高尿酸血症风险增加有关，而肉类摄入与高尿酸血症发生的关联竟然不大。该研究发表于《Arthritis Care & Research》。

研究一共纳入71893名参与者，平均年龄51.4岁，男性占比80.6%，既往无痛风病史。

通过问卷调查的形式记录其2014年一整年的饮食情况，按照得舒饮食强调增加或减少摄入的9类食物摄入情况，对每位参与者的饮食进行得舒饮食模式评分。

其中，蔬菜、水果、乳制品、豆类、全谷物摄入越多，得分越高；相反，盐、肉类、脂肪和含糖饮料摄入越多，得分越低，每类食物得分在1-5分之间。

通过血液分析得到这些参与者们同一时期的血尿酸浓度，男性血尿酸浓度≥7mg/dl（416mmol/L），女性血尿酸浓度≥6mg/dl（357mmol/L）定义为高尿酸血症。

在校正了年龄、性别、热量摄入、BMI、体力活动、受教育程度、吸烟、饮酒情况后，研究人员发现：得舒饮食模式评分最高的前1/4参与者相较于评分最低的后1/4参与者，患高尿酸血症的风险下降了30%，且这种关联在年龄≥50岁的人、女性以及不经常运动的人身上更加明显。

即使在剔除了那些患有慢性肾病、肥胖、糖尿病、高血压、心梗和中风的参与者后，结论依然成立。

不仅如此，研究人员还特别分析了得舒饮食中的每一类食物与高尿酸血症之间的关联，结果显示：多摄入蔬菜、水果、全谷物，少摄入脂肪、含糖饮料、豆类、乳制品，与高尿酸血症发病风险降低有关。

少摄入含糖饮料与高尿酸血症风险下降有关，这一结论与以往的研究结论相符。含糖饮料虽然嘌呤含量低，但饮料中的果糖却能够在肝脏代谢过程中产生尿酸生成前体，导致血尿酸水平升高，因此，高血尿酸人群不但应该少喝含糖饮料，连糖分较高的水果也应该少吃。

除此之外，本研究还表明豆类摄入与高尿酸血症升高有关，实际上，大豆中的嘌呤含量（167.5mg/100g）甚至比鱼类（约130mg/100g）还高。

不过也有一些研究显示食用豆制品可以降低痛风风险，这可能是因为大豆在经过加工成为豆制品之后，嘌呤含量已经大幅下降，因此2019年的《中国高尿酸血症与痛风指南》中既不推荐也不限制豆制品的摄入。

至于乳制品为什么与高尿酸血症风险上升有关，研究人员认为，中国人乳制品的摄入普遍偏少，即使是乳制品摄入评分最高的人平均每日摄入乳制品的量也才133.5克，对乳制品的偏好可能反映了参与者对西方饮食习惯的适应，而西方饮食习惯正是高尿酸血症的危险因素。

好消息是，在本研究中，并未发现肉类摄入与高尿酸血症发生有显著关联，与之前在台湾人、以及上海人中开展的研究得到的结论一致！

综上所述，采用得舒饮食方式预防高尿酸血症及痛风发生同样适用于中国人群，期待有更多关于中国人群的痛风饮食的前瞻性研究开展，使得饮食与痛风的因果关系更清晰明了，而我们对痛风饮食知识的了解也将不断更新。

参考资料：

[1]Gao Y, Cui LF, Sun YY, et al. Adherence to the Dietary Approaches to Stop Hypertension Diet and Hyperuricemia: A Cross-Sectional Study. Arthritis Care Res (Hoboken). 2021;73(4):603-611. doi:10.1002/acr.24150

[2]Rai SK, Fung TT, Lu N, Keller SF, Curhan GC, Choi HK. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ. 2017;357:j1794. Published 2017 May 9. doi:10.1136/bmj.j1794

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[GetPortalCommentsPageByObjectIdResponse(id=2106950, encodeId=fb2e210695029, content=哈哈，果然和我自己的直觉感受一样，怪不得每次吃多了豆腐胃就泛酸水, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b30f5608508, createdName=ms2000001984146267, createdTime=Wed Dec 21 15:18:43 CST 2022, time=2022-12-21, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=1228364, encodeId=6ffc1228364c3, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0238210780, createdName=ms1000001750857735, createdTime=Fri Jun 24 09:11:23 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228353, encodeId=b63d122835332, content=得舒方案依足量，减量，适量，控制分布。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db4b1699215, createdName=1de78fb9m22(暂无匿称), createdTime=Fri Jun 24 08:39:42 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228352, encodeId=ae7812283524b, content=这个研究，怎么说呢，还是有问题，饮食这个问题，特别是通过询问来研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ffe15705834, createdName=ms4000001809038213, createdTime=Fri Jun 24 08:38:07 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228345, encodeId=0f6912283451f, content=得舒饮食，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32b38214898, createdName=可乐er, createdTime=Fri Jun 24 07:48:29 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228343, encodeId=91da12283439f, content=还让不让喝豆浆啦？, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37f85627557, createdName=ms1000000346628851, createdTime=Fri Jun 24 07:33:58 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227937, encodeId=e5f4122e937d0, content=学习学校, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89e15520639, createdName=ms7000000527650606, createdTime=Wed Jun 22 09:43:04 CST 2022, time=2022-06-22, status=1, ipAttribution=)]
2022-12-21 ms2000001984146267 来自河北省

哈哈，果然和我自己的直觉感受一样，怪不得每次吃多了豆腐胃就泛酸水

31 0
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2022-06-24 ms1000001750857735

学习学习

48 0
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2022-06-24 1de78fb9m22(暂无匿称)

得舒方案依足量，减量，适量，控制分布。

43 0
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2022-06-24 ms4000001809038213

这个研究，怎么说呢，还是有问题，饮食这个问题，特别是通过询问来研究

44 0
[GetPortalCommentsPageByObjectIdResponse(id=2106950, encodeId=fb2e210695029, content=哈哈，果然和我自己的直觉感受一样，怪不得每次吃多了豆腐胃就泛酸水, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b30f5608508, createdName=ms2000001984146267, createdTime=Wed Dec 21 15:18:43 CST 2022, time=2022-12-21, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=1228364, encodeId=6ffc1228364c3, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0238210780, createdName=ms1000001750857735, createdTime=Fri Jun 24 09:11:23 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228353, encodeId=b63d122835332, content=得舒方案依足量，减量，适量，控制分布。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db4b1699215, createdName=1de78fb9m22(暂无匿称), createdTime=Fri Jun 24 08:39:42 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228352, encodeId=ae7812283524b, content=这个研究，怎么说呢，还是有问题，饮食这个问题，特别是通过询问来研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ffe15705834, createdName=ms4000001809038213, createdTime=Fri Jun 24 08:38:07 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228345, encodeId=0f6912283451f, content=得舒饮食，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32b38214898, createdName=可乐er, createdTime=Fri Jun 24 07:48:29 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228343, encodeId=91da12283439f, content=还让不让喝豆浆啦？, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37f85627557, createdName=ms1000000346628851, createdTime=Fri Jun 24 07:33:58 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227937, encodeId=e5f4122e937d0, content=学习学校, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89e15520639, createdName=ms7000000527650606, createdTime=Wed Jun 22 09:43:04 CST 2022, time=2022-06-22, status=1, ipAttribution=)]
2022-06-24 可乐er

得舒饮食，学习了

42 0
[GetPortalCommentsPageByObjectIdResponse(id=2106950, encodeId=fb2e210695029, content=哈哈，果然和我自己的直觉感受一样，怪不得每次吃多了豆腐胃就泛酸水, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b30f5608508, createdName=ms2000001984146267, createdTime=Wed Dec 21 15:18:43 CST 2022, time=2022-12-21, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=1228364, encodeId=6ffc1228364c3, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0238210780, createdName=ms1000001750857735, createdTime=Fri Jun 24 09:11:23 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228353, encodeId=b63d122835332, content=得舒方案依足量，减量，适量，控制分布。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db4b1699215, createdName=1de78fb9m22(暂无匿称), createdTime=Fri Jun 24 08:39:42 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228352, encodeId=ae7812283524b, content=这个研究，怎么说呢，还是有问题，饮食这个问题，特别是通过询问来研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ffe15705834, createdName=ms4000001809038213, createdTime=Fri Jun 24 08:38:07 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228345, encodeId=0f6912283451f, content=得舒饮食，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32b38214898, createdName=可乐er, createdTime=Fri Jun 24 07:48:29 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228343, encodeId=91da12283439f, content=还让不让喝豆浆啦？, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37f85627557, createdName=ms1000000346628851, createdTime=Fri Jun 24 07:33:58 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227937, encodeId=e5f4122e937d0, content=学习学校, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89e15520639, createdName=ms7000000527650606, createdTime=Wed Jun 22 09:43:04 CST 2022, time=2022-06-22, status=1, ipAttribution=)]
2022-06-24 ms1000000346628851

还让不让喝豆浆啦？

41 0
[GetPortalCommentsPageByObjectIdResponse(id=2106950, encodeId=fb2e210695029, content=哈哈，果然和我自己的直觉感受一样，怪不得每次吃多了豆腐胃就泛酸水, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b30f5608508, createdName=ms2000001984146267, createdTime=Wed Dec 21 15:18:43 CST 2022, time=2022-12-21, status=1, ipAttribution=河北省), GetPortalCommentsPageByObjectIdResponse(id=1228364, encodeId=6ffc1228364c3, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e0238210780, createdName=ms1000001750857735, createdTime=Fri Jun 24 09:11:23 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228353, encodeId=b63d122835332, content=得舒方案依足量，减量，适量，控制分布。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db4b1699215, createdName=1de78fb9m22(暂无匿称), createdTime=Fri Jun 24 08:39:42 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228352, encodeId=ae7812283524b, content=这个研究，怎么说呢，还是有问题，饮食这个问题，特别是通过询问来研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ffe15705834, createdName=ms4000001809038213, createdTime=Fri Jun 24 08:38:07 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228345, encodeId=0f6912283451f, content=得舒饮食，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=32b38214898, createdName=可乐er, createdTime=Fri Jun 24 07:48:29 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228343, encodeId=91da12283439f, content=还让不让喝豆浆啦？, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=37f85627557, createdName=ms1000000346628851, createdTime=Fri Jun 24 07:33:58 CST 2022, time=2022-06-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1227937, encodeId=e5f4122e937d0, content=学习学校, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=89e15520639, createdName=ms7000000527650606, createdTime=Wed Jun 22 09:43:04 CST 2022, time=2022-06-22, status=1, ipAttribution=)]
2022-06-22 ms7000000527650606

学习学校

33 0

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