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Kersen tegen jicht*
Uit een Amerikaanse studie onder 633 patiënten met jicht blijkt dat het eten van kersen de kans op een jichtaanval flink kan verminderen. Na 2 dagen kersen (per dag 10 tot 12) of kersenextract eten blijkt de kans op een jichtaanval met resp. 35 en 45% afgenomen te zijn. Met het veel gebruikt geneesmiddel bij jicht Allopurinol, een geneesmiddel dat de aanmaak van urinezuur tegengaat, is de lagere kans 53%. Kersen eten samen met dit middel verlaagt de kans op een jichtaanval met 75% zo blijkt uit de studie. Het eten van meer kersen leverde geen extra voordeel.
Cherries May Prevent Gout Flares
Patients with gout were less likely to report acute attacks after 2 days of eating cherries or imbibing cherry extract than during periods after no cherry intake, according to data reported in Arthritis & Rheumatism by Yuqing Zhang, DSci, and colleagues from Boston University School of Medicine in Massachusetts.
Dr. Zhang, who is professor of medicine and epidemiology at Boston University School of Medicine, told Medscape Medical News that cherry intake during a 2-day period was associated with a 35% lower risk for gout attacks and that cherry extract intake was associated with a 45% lower risk.
Risk for gout attacks was reduced by 75% when cherry intake was combined with allopurinol use. Dr. Zhang said, "We found that if subjects took allopurinol alone, it reduced the risk of gout attack by 53%; if subjects took cherry alone, it reduced the risk by 32%; if they took both, the risk of gout attack was reduced by 75%."
These associations were discovered in a case-crossover study of 633 individuals with physician-diagnosed gout who were prospectively recruited and followed online for 1 year. When a participant reported a gout attack, the researchers asked about the onset date of the gout attack, symptoms and signs, medications, and potential risk factors (including daily intake of cherries and cherry extract) during the 2 days before the attack. Patients served as their own controls, so the same information was assessed for 2-day control periods not associated with gout attacks. A cherry serving was defined as one-half cup or 10 to 12 cherries.
Participants had a mean age of 54 years; 88% were white and 78% were male. Of patients with some form of cherry intake, 35% ate fresh cherries, 2% ingested cherry extract, and 5% consumed both fresh cherry fruit and cherry extract. Researchers documented 1247 gout attacks during the 1-year follow-up period, with 92% occurring in the joint at the base of the big toe.
Factors associated with increased serum uric acid levels, such as increased alcohol consumption and purine intake, or use of diuretics, were associated with increased risk for recurrent gout attacks.
"Our findings indicate that consuming cherries or cherry extract lowers the risk of gout attack," Dr. Zhang said in a press release. "The gout flare risk continued to decrease with increasing cherry consumption, up to three servings over two days." Further cherry intake was not associated with additional benefit.
"However, the protective effect of cherry intake persisted after taking into account patients' sex; body mass (obesity); purine intake; and use of alcohol, diuretics, and antigout medications," according to the release.
The authors speculate that cherries may decrease serum uric acid levels by increasing glomerular filtration or reducing tubular reabsorption. They also note that cherries and cherry extract contain high levels of anthocyanins, which possess anti-inflammatory properties.
Dr. Zhang told Medscape Medical News, "While our study findings are promising, randomized clinical trials should be conducted to confirm whether cherry products could provide a nonpharmacological preventive option against grout attacks. Until then we would not advocate on the basis of the current findings that individuals who suffer from gout abandon standard therapies and opt for cherry extract products as an alternative."
In an accompanying editorial, Allan Gelber, MD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, and Daniel Solomon, MD, from Brigham and Women's Hospital and Harvard University Medical School in Boston, write that the findings are promising but reiterates the need for randomized clinical trials to confirm that consumption of cherry products could prevent gout attacks.
Dr. Gelber told Medscape Medical News, "For the patient who asks his/her doctor 'Doc, what can I do, myself, to decrease my chance of developing another gout attack, above and beyond the medications you have prescribed for me?' our response would include that one of the options is dietary modification. Previously, physician recommendations included advocating for moderation in alcohol consumption, weight reduction, and decreasing high-purine foods from the diet…but now there are new data supporting a beneficial role in eating cherries to reduce one's risk for recurrent gout attacks."
Dr. Gelber noted that the most definitive support for the recommendation to eat cherries as a strategy to reduce gout risk would come from a randomized clinical trial. "Just as with new medications that come down the pipeline, dietary interventions ought also be subject to the rigor of a clinical trial. Such a study could be undertaken. There is logistical challenge to undertaking such a trial since cherry fruit is broadly available. But, in a controlled setting, such a trial would be feasible," he said.
This research was funded by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Arthritis Foundation, and American College of Rheumatology Research and Education Fund. Dr. Zhang, Dr. Gelber, and Dr. Solomon have disclosed no relevant financial relationships.
Cherry consumption and the risk of recurrent gout attacks
1. Yuqing Zhang1,†,*, 2. Tuhina Neogi1, 3. Clara Chen2, 4. Christine Chaisson2, 5. David Hunter3, 6. Hyon K. Choi1
Copyright © 2012 by the American College of Rheumatology
To study the relation between cherry intake and the risk of recurrent gout attacks among individuals with gout.
We conducted a case-crossover study to examine associations of a set of putative risk factors with recurrent gout attacks. Individuals with gout were prospectively recruited and followed online for one year. Participants were asked about the following information when experiencing a gout attack: the onset date of the gout attack, symptoms and signs, medications (including anti-gout medications), and potential risk factors (including daily intake of cherries and cherry extract) during the 2-day period prior to the gout attack. We assessed the same exposure information over 2-day control periods. We estimated the risk of recurrent gout attacks related to cherry intake using conditional logistic regression.
Our study included 633 individuals with gout. Cherry intake over a 2-day period was associated with a 35% lower risk of gout attacks compared with no intake (multivariate odds ratio [OR] = 0.65, 95% CI: 0.50-0.85). Cherry extract intake showed a similar inverse association (multivariate OR=0.55, 95% CI: 0.30-0.98). The effect of cherry intake persisted across subgroups by sex, obesity status, purine intake, alcohol use, diuretic use, and use of anti-gout medications. When cherry intake was combined with allopurinol use, the risk of gout attacks was 75% lower than periods without either exposure (OR=0.25, 95% CI: 0.15-0.42).
These findings suggest that cherry intake is associated with a lower risk of gout attacks. © 2012 American College of Rheumatology. (Oktober 2012)