Which of the following diets is preferred in patients with gout?

Appeared in: DSSSB 14 August 2024

Explanation

Gout is a metabolic disorder characterized by high levels of uric acid in the blood (hyperuricemia).
Uric acid is the end product of purine metabolism. Purines are found in many foods.
A low-purine diet reduces the intake of purine precursors, which in turn decreases the body's production of uric acid.
Lowering serum uric acid levels helps prevent the crystallization of urate in joints, which is the direct cause of painful gout attacks.

Option B: A high sodium diet does not directly affect purine metabolism or uric acid levels. It is generally discouraged as it can lead to hypertension and fluid retention, which are common comorbidities in patients with gout.
Option C: A high-fat diet can impair the renal excretion of uric acid, leading to its accumulation in the blood. It also contributes to obesity, a major risk factor for developing gout.
Option D: This is the opposite of the correct management. A high-purine diet would introduce more purines into the body, leading to increased uric acid production and directly triggering or worsening gout attacks.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Dietary management for gout as background academic context rather than a clinical decision trigger.
Patient education on diet is a critical nursing responsibility to empower patients for self-management and prevent recurrent, painful gout attacks.
Nurses should emphasize the importance of hydration (2-3 L/day) as it helps the kidneys flush out excess uric acid, reducing the risk of both gout flares and kidney stones.
What if? If a patient with gout also has chronic kidney disease (CKD), dietary advice becomes more complex. The nurse must collaborate with a dietitian to balance purine restriction with protein and fluid restrictions required for CKD management.

How to Approach the Question

First, identify the key term in the question stem, which is 'gout'.
Recall the basic pathophysiology of gout: it is a disorder of 'purine' metabolism that leads to high levels of 'uric acid'.
Based on this, deduce the goal of dietary therapy: to reduce the substance that causes the problem. Therefore, the diet must aim to lower purine intake.
Evaluate the options. 'Low purine diet' directly addresses the cause. 'High purine diet' would worsen it. 'High sodium' and 'high fat' are related to general health but are not the primary dietary cause of gout.

Concept Tested & Keywords

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E6 Nutrition Monika Sharma 3e pp. 247-249, 246-248

E6 Medicine Harrison 22e Part 2 p. 863-865

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