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. 2024 Nov 27;16(23):4066. doi: 10.3390/nu16234066

Daily Amount of Purine in Commonly Recommended Well-Balanced Diets in Japan and Overseas

Kiyoko Kaneko 1,2,*, Keito Tsuruga 3, Fukue Takayanagi 4, Tomoko Fukuuchi 2, Noriko Yamaoka 2, Reiko Seki 1, Shin Fujimori 5
Editor: Maurizio Cutolo
PMCID: PMC11643512  PMID: 39683460

Abstract

Background/Objectives: A low purine diet has been recommended for patients with gout and hyperuricemia, but there are concerns about excessive carbohydrates and a lack of protein. A well-balanced diet in accordance with general dietary guidelines is widely recommended. The Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet are also recommended for gout and hyperuricemia patients. However, there is little information on the purine levels in these diets. The aim of this study is to determine the daily amount of purine in well-balanced diets that follows the dietary guidelines, including the Mediterranean diet and the DASH diet. Methods: We measured the purine content in various foodstuffs. Using these values, we calculated the amount of purine in generally recommended well-balanced diets—the Japanese diet, American My Plate Plan, the Mediterranean diet, and the DASH diet. To calculate the amount of purine, recipes tailored to the characteristics of each diet were created. Results: The amount of purine in the Japanese diet, in the American My Plate Plan, in the Mediterranean diet, and in the DASH diet were 308.5–366.1, 308.7–335.0, 346.6–394.1, 325.9–493.9 mg/day, respectively. These values were close to the 400 mg/day recommended in the Japanese Guideline for the management of Hyperuricemia and Gout. Conclusions: A well-balanced diet following the recommendation in the dietary guidelines is considered to provide adequate purines. Because a high purine diet can lead to the recurrence of gout, advising to eat a balanced diet is useful on lifestyle guidance for the patients with gout and hyperuricemia.

Keywords: amount of purine, gout and hyperuricemia, well-balanced diet, food guidelines, Mediterranean diet, DASH diet

1. Introduction

Purines that have a purine ring as a chemical structure contain various types including nucleic acids such as DNA and RNA, nucleotides such as ATP and GMP, nucleosides such as adenosine, and purine bases. These purines in the body are used for cell division, energy metabolism, and signal transduction, and in humans, are ultimately excreted from the kidneys and intestinal tract as uric acid (Figure 1). Uric acid is mainly produced in the liver, circulates in the blood, and about two-thirds is excreted in urine from the kidneys and about one-third is excreted in feces from the digestive tract [1]. Since uric acid is poorly soluble in water, excess uric acid not only increases serum uric acid levels but also crystallizes as monosodium urate crystals in joints and other areas, causing gouty arthritis.

Figure 1.

Figure 1

Purine metabolism and Dietary purine.

Foods and beverages that we consume also contain cellular nucleic acids, nucleotides, nucleosides, and bases that are converted into uric acid. Purines are a source of energy for the body, especially for the intestinal tract, but excessive intake of purine can increase serum uric acid levels. It has been known since medieval Europe that gout was common among gourmets and heavy drinkers, and that there is a link between diet and gout [2]. A low purine diet has been recommended for patients with gout and hyperuricemia, but there are concerns about excessive carbohydrates and a lack of protein [3].

The number of patients with gout is rising in developed countries, not only in Japan. According to the Basic Survey on National Life in Japan, the number of patients who visited hospitals for gout (gouty arthritis) in 2022 was 1.236 million men and 70,000 women, totaling 1.306 million, which, for both genders, shows increments from 2019 (1.195 million men, 59,000 women, totaling 1.254 million) and 2016 (1.048 million men, 57,000 women, totaling 1.105 million). Relative to gout patients since 1998, the number has increased by about 100,000 every three years on average [4].

Hyperuricemia is defined as a serum uric acid level above 7.0 mg/dL in both men and women [5]. Hyperuricemia causes uric acid deposition diseases (gouty arthritis, renal disorders, etc.) [6], and the number of patients is estimated to be about 10 times that of gout patients, so the number of hyperuricemia patients in Japan is thought to exceed 13 million. The frequency of hyperuricemia is one in four or five adult men, which is the same as in other countries [7].

It has been reported that hyperuricemia is associated with increased BMI and hypertension [8], and has been listed as a risk factor of cardiovascular disease that affects life prognosis [9]. Hyperuricemia is also associated with renal disorders, urinary stones, diabetes, and metabolic syndrome. It is important to keep serum uric acid levels within the standard range in order to prevent other lifestyle-related diseases [5]. In particular, ischemic cardiovascular diseases such as strokes have a high prognosis of being bedridden, so preventing hyperuricemia is important in terms of extending healthy life expectancy [9].

A report examining the relationship between diet and serum uric acid levels also found that the more meat and fish consumed, the higher the serum uric acid level and the higher the risk of developing gout [10]. It has been reported that excessive intake of purines increases the risk of gout recurrence [11]. According to a meta-analysis summarizing foods and the risk of hyperuricemia, foods that increase serum uric acid level include red meat, seafood, alcohol, and fructose [12]. Thus, the 2020 ACR guideline for the management of gout conditionally recommends limiting purine intake [13].

A study addressing the possibility of dietary prevention on serum urate and cardiovascular disease found that significant benefits were seen following a low-fat, Mediterranean, or low-carbohydrate weight loss diets [14]. The Mediterranean diet/DASH (Dietary Approaches to Stop Hypertension) has been reported to lower serum uric acid levels [15,16] and reduce cardiovascular risk factors in other at-risk populations [17]. Diet plays an important role for patients with gout and hyperuricemia [16,18].

Although there are reports on the purine content of foods [19], there are few reports on the amount of purine in the diet [20,21], and, to our knowledge, no reports on the Mediterranean diet or DASH diet. A balanced diet in accordance with general dietary guidelines is also recommended for patients with gout and hyperuricemia. Thus, in this study, we compiled the purine content of diets that are considered to be effective for patients with gout and hyperuricemia, specifically, generally recommended well-balanced diets based on the dietary guidelines, the Mediterranean diet, and the DASH diet.

2. Methods

2.1. Determination of Purine Content in Food

We continued to measure the purine content of foods and improved our methods [19,22]. The foods were purchased from retail stores, pretreated, hydrolyzed, and analyzed by high-performance liquid chromatography (HPLC). Briefly, food samples were hydrolyzed with 70% perchloric acid at 95 °C under stirring for 60 min. By way of this process, the nucleic acids, nucleotides, and nucleosides present in the samples were converted to the corresponding bases: adenine, guanine, hypoxanthine, and xanthine. These four purine bases were then accurately identified and quantified by HPLC implementing the peak-shift method. After adding xanthine oxidase (8.9 U/mL) and glycylglycine buffer (pH 8.2) to obtain the reaction solution of the sample, mixture was incubated at 37 °C for 3 h and was subjected to our inspection of the disappearance of the peaks of all analytes. Total purine content was calculated by the sum of each purine base

HPLC conditions were as follows: instrument, Shimadzu LC10A HPLC system with autoinjector SIL-10AD (Kyoto, Japan); column, Shodex Asahipak GS-320HQ (7.6 mm i.d. and 300 mm length) (Tokyo, Japan); mobile phase, 150 mM sodium phosphate buffer (pH 2.5–2.8); flow rate, 0.6 mL/min; column temperature, 35 °C; and detector wavelength, 260 nm.

2.2. Typical Dietary Guideline Survey

As typical dietary guidelines, we investigated the Dietary Reference Intake and Dietary Guideline [23,24]. For Japanese patients, we referred to the Japanese Food Guide Spinning Top that is designed by the Ministry of Agriculture, Forestry, and Fisheries of Japan (Figure 2a) [25]. For patients in USA, the My Plate Plan [26] proposed by the U.S. Food and Drug Administration (FDA) and United States Department of Agriculture (USDA) were referred to (Figure 2b). As both the Mediterranean diet [27,28] and the DASH diet [29,30] were reported to be effective for patients with gout or hyperuricemia through several studies [3,14,15,16,17,18], diets based on these eating patterns were also used as a guide (Figure 2c,d).

Figure 2.

Figure 2

Figure 2

(a) Japanese Food Guide (Japanese Food Guide Spinning Top). The Ministry of Agriculture Forestry and Fishers. The Ministry of Health Labor and Welfare Japanese Food Guide Spinning Top. Available online: https://www.fao.org/nutrition/education-nutritionnelle/food-dietary-guidelines/regions/japan/en/ (accessed on 21 November 2024). (b) American Healthy Eating Plate (My Plate Plan). U.S. Department of Agriculture. MyPlate: Available online: https://www.myplate.gov/eat-healthy/what-is-myplate (accessed on 21 November 2024). (c) Mediterranean diet [27]. Serra-Majem, L. et al. (d) DASH diet. U.S. National Heart, Lung, and Blood Institute: Available online: https://www.nhlbi.nih.gov/education/dash-eating-plan (accessed on 21 November 2024).

2.3. Creating Recipes for Each Dietary Guideline and Calculating Daily Purine Amount

Recipes were created based on the Japanese Food Guide Spinning Top and the Japan Diet [31], the My Plate Plan, the Mediterranean diet, and the DASH diet [23,24,27]. These dietary guidelines have their own recommended ingredients and quantities, as well as frequency of intake, as shown in Figure 2. We created three days’ worth of recipes based on the characteristic instructions, then we calculated the daily purine amount in each diet. Recipes for the Mediterranean diet and the DASH diet were created by combining recipes from books that described each diet and menu, to fit the instructions in the guidelines [32,33]. When calculating daily purine amount, we used our reported data and, if the purine content of a food was not measured, the value of a similar food was used instead of that.

The Japan diet is a dietary pattern derived from washoku (Japanese cuisine) that has been registered in 2013 as a world intangible cultural heritage by United Nations Educational, Scientific and Cultural Organization (UNESCO), and is a dietary approach recommended by the Japan Atherosclerosis Society [31,34]. In Japan, the basic meal combination of a staple food, main dish, one or two side dishes, and soup has long been advocated, as recommended in the Japan Diet. The Japan Diet is a dietary method targeted at patients with high risk of arteriosclerosis, who have high levels of LDL-cholesterol or triglycerides. For this reason, eggs are listed as a food to be avoided. In contrast, our study targeted patients with hyperuricemia and gout. Therefore, a recipe was created using eggs, which contain almost no purines that are the precursor of uric acid, and which are a good source of protein.

Figure 3 summarizes traditional Japanese dietary pattern, as typified by washoku and the Japan Diet, along with some key points to consider regarding purines. A typical combination of Japanese diet includes a staple food, a main dish, one or two side dishes, and soup. Seafood and meat are high in purines whereas other foods (grains, soy product, vegetable, egg, seaweed, mushroom) are low in purines. It is also recommended to eat a balanced diet containing an appropriate amount of energy according to age, height and physical activity, aiming for 30 different types of food per day.

Figure 3.

Figure 3

Japanese dietary pattern with some key points regarding purine.

3. Results

3.1. Purine Content of Commonly Used Foodstuffs

The purine content of commonly used foodstuffs is shown in Table 1. In addition to previous report [19], recently measured and unpublished purine contents are also shown [35,36]. Purine content is shown per 100 g by the food. Dry foods have a lower moisture content and condensed purines, so they show higher values.

Table 1.

Purine content of commonly used foodstuffs.

(mg/100g) (mg/100g) (mg/100g) (mg/100g)
Grains Purine Vegetables(colored) Purine Meat Purine Fresh Fish Purine
Barley 44.3 Balsam pear (Goya) 9.9 Pork Anchovy 272.8
Bread 4.4 Broccoli 61.9 Shoulder 81.4 Bonito 211.4
Buckwheat 7.7 Carrot 2.2 Ribs 75.8 Codfish 98
Dumpling Wrappers 13.4 Cilantro 39.5 Tenderloin 119.7 Flounder (Hirame) 133.4
Flour (bread flour) 25.8 Green beans 7.4 Sirloin 90.9 Halibut 113
Flour (cake flour) 15.7 Green pepper 2.4 Liver 284.8 Japanese Salmon 119.3
Oatmeal 35 Komatsuna 10.6 Japanese seabass 119.5
Rice (polished) 25.9 Mitsuba 11.6 Beef
Rice (unpolished) 37.4 Parsley 288.9 Shoulder ribs 77.4 Pacific saury 154.9
Rice (with the bud) 34.5 Perilla leaves (shiso) 41.4 Shoulder sirloin 90.2 Rainbow trout 180.9
Spaghetti 6.8 Radish (leaf) 33.6 Shin 106.4 Red seabream 128.9
Udon 12.1 Red Paprika 1 Tenderloin 98.4 Salmon 176.5
Spinach 51.4 Thigh 110.8 Tuna 157.4
Beans Purine Liver 219.8
Azuki bean (dried) 77.6 Vegetables (other) Purine Chicken Seafood Purine
Black bean (dried) 67.1 Asparagus 32.8 Wing 137.5 Pacific flying squid 186.8
Broad bean 35.5 Bamboo shoot 47.1 White meat 153.9 Spear squid 160.5
Chickpeas 26.1 Bean sprouts 35 Leg 122.9 Octopus 137.3
Green peas 21.8 Cabbage 3.2 Breast 141.2 Shiba shrimp 144.2
Green peas (canned) 18.8 Cauliflower 57.2 Liver 312.2 Tiger Prawn 192.3
Green Soybean 47.9 Cherry Tomato 3.1 Mutton Snow crab 136.4
Red peas 25.4 Chinese cabbage 7 Mutton 96.2 Clam 145.5
Soybean (dried) 172.5 Corn 11.7 Rum 93.5 Oyster 184.5
Cucumber 9.4 Duck 163.9 Mussels 292.5
Soybean products Purine Eggplant 50.7 Horse 140.8 Scallop 104.9
Fermented (Natto) 56.6-113.9 Garlic 17 Venison 140.4 Kamaboko 26.4
Soymilk 19.3-22.0 Ginger 2.3 Wild boar 91.7 Katsuobushi (flake) 493.3
Tofu 20.0-31.1 Japanese leek (negi) 41.4 Rabbit 130.7
Lettuce 4.6 Boneless ham 74.2 Seasoning Purine
Nuts/Seeds Purine Mizuna 20.2 Vienna sausage 45.5 Barbecue sauce 14.9
Almond 31.4 Onion 2.3 Bacon 74.8 Chicken soup stock 508.9
Chia Seed 58.6 Radish (root) 1.7 Consomme (powder) 179.8
Peanut 49.1 Tomato 6.5 Fruit Purine Honey 0.9
Sesame 36.3 Zucchini 13.1 Avocado 18.4 Ketchup 10.5
Walnut 19.6 Banana 3 Mayonnaise 0.6
Potatoes Purine Kiwi 1.8 Mirin 1.2
Eggs Purine Pumpkin (Kabocha) 56.6 Mandarin Orange 1.7 Miso (red miso) 63.5
Chicken egg 0 Potato 6.5 Strawberry 2.1 Miso (white miso) 48.8
Sweet potato 17 Shishito pepper 5.1
Dairy products Purine Beverages Purine Soy sauce 45.2
Butter 0 Mushrooms Purine Fruit juice 1.1 Tomato paste 10.9
Cheese 6 Bunashimeji 20.8 Tomato juice 6.2 Umami broth (Bonito) 684.8
Fresh cream 0.3 Eringi 13.4 Vegetable juice 13.7 Wasabi 0.7
Fresh cream (veg) 0.1 Mushroom 49.5 Japanese sake 1.5
Shiitake (raw) 20.8 Red Wine 1.6
Grated cheese 12.9 White Wine 1.6
Margarine 0 Dried seaweeds Purine
Milk 0.16 Hijiki 132.8 Others Purine
Milk (low fat) 0.15 Kombu 46.4 Chocolate 8.1
Yogurt 5.2 Nori 591.7 Konjac 0.3
Wakame 262.4 Vermicelli 0.6

Purines are generally found in plants and animals, and the parts of them that have a large number of cells, or where cell division is active, contain a high amount of purine. Purine content is high in meat, fish, and seafood derived from animals, and low in vegetables and fruits derived from plants.

Purines are mainly derived from nucleic acids, nucleotides, and nucleosides, and are therefore water-soluble. Accordingly, the purine content is reduced by boiling and is lower in canned and processed foods than in the original ingredients.

3.2. Japanese Well-Balanced Diet and a Daily Amount of Purine in It

A well-balanced diet was determined by aligning ingredients and portions with the Japanese Food Guide Spinning Top and by consuming foods in accordance with traditional Japanese eating habits (Figure 4). This diagram was created to help users visualize the recommended daily amount of intake when they hold each ingredient in their hand.

Figure 4.

Figure 4

A well-balanced diet based on the Japanese Food Guide Spinning Top.

Staple foods were divided into three meals and consisted of rice, bread, and udon noodles, with purine contents of 23.3 mg, 2.6 mg, and 24.3 mg, respectively. It is recommended that the ratio of light-colored vegetables to colored vegetables be 2:1 for side dishes. This is 220 g of light-colored vegetables and 140 g of colored vegetables, for a total of 360 g, which meets the daily vegetable intake of 350 g or more recommended by Health Japan 21 [37]. For the main dish, it is recommended to have both meat and fish every day. Therefore, we chose chicken and salmon from the frequently eaten foods, along with tofu as a soy product, and eggs. Eggs are often mistakenly thought to contain a lot of purines, but the purine content was almost 0 mg/100 g. The amount of purine from the main dish and side dishes was 224.8 mg and 87.2 mg, respectively. It is recommended to eat one type of fruit per day, but care must be taken not to consume too much fructose in fruit. It has also been reported that the intake of milk and dairy products reduces serum uric acid levels, so it is recommended to actively consume them. The amount of purine from fruits and dairy products was 1.7 mg and 5.2 mg, respectively.

The total daily amount of purine and the daily energy derived from these food ingredients were 369.1 mg and 1930 kcal, respectively. Seasonings and cooking oil are used in cooking, so we add the amounts (purine: 16.2 mg, energy: 210 kcal) calculated from Table 2, the total comes to 385.3 mg and 2.140 kcal, respectively. This amount of purine is in line with the recommended daily purine intake of about 400 mg as set out in the Japanese Guideline for the Treatment of Hyperuricemia and Gout [5].

3.3. Recipes Based on Dietary Guidelines and Daily Amount of Purine

The recipes created in accordance with each guideline, along with their respective energy intake and purine amounts, are shown in Table 2, Table 3, Table 4 and Table 5.

The Japanese diet shown in Table 2 consists of three meals—breakfast, lunch and dinner—and uses grains, meat, fish, vegetables, soy product, seaweed, dairy products, and fruit. These recipes are generally considered to feature well-balanced meals that include multiple dishes, such as a main dish, side dishes, staple foods, and a soup. The daily amount of purine and energy intake of these recipes are 308.5–366.1 mg and 1830–1918 kcal, respectively.

The recipes created based on the American Healthy Eating Plate, the My Plate Plan, are shown in Table 3. It consists of three meals—breakfast, lunch and dinner—and uses unrefined grains, beans, fish or seafood, meat, vegetables, dairy products, soy product, and fruit. The recipes are designed to help us consume the recommended amounts of fruits, vegetables, grains, protein, and dairy products using My Plate Plan, resulting in a balanced diet. The daily amount of purine and energy intake of these recipes are 308.7–335.0 mg and 1832–2010 kcal, respectively.

The recipes created according to the Mediterranean diet are shown in Table 4. It consists of four meals—breakfast, snacks, lunch, and dinner—and uses vegetables, beans, nuts, unrefined grains, fish or seafood, meat, dairy products, and fruit. The Mediterranean diet recommends lunch as the main meal, and that we consume a lot of whole grains, seasonal vegetables and fruits, legumes, nuts, and fish and seafood. These recipes are created in accordance with this characteristic and are considered to achieve a balanced meal. The daily amount of purine and energy intake based on these recipes are 346.6–394.0 mg and 1510–2287 kcal, respectively.

In Table 5, the recipes created according to the DASH diet are indicated. It consists of five meals—breakfast, snacks, lunch, snacks, and dinner—and uses vegetables, legumes/beans, mushrooms, fish or seafood, meat, dairy products, and fruit. The DASH diet recommends a focus on whole grains, vegetables, and fruits, along with fish, poultry, beans, nuts, and low-fat dairy products. These recipes are designed to follow this principle to provide a balanced diet. The daily amount of purine and energy intake of these recipes are 325.9–493.9 mg and 1600–1713 kcal, respectively. Since 200 g of chicken (which contains more purine than other meats (Table 1)) is consumed at dinner in recipe 2, the daily amount of purine is increased. But the energy intake of the meal was as low as 265 kcal.

Table 2.

Japanese diet based on the Japanese Food Guide Spinning Top.

Recipe 1 Recipe 2 Recipe 3
Breakfast Energy
(kcal)
Purine
(mg)
Breakfast Energy
(kcal)
Purine
(mg)
Breakfast Energy
(kcal)
Purine
(mg)
Bread 196 2.6 Bread 196 2.6 Bread 196 2.6
(Bread, Orange Marmalade) (Bread, Strawberry jam) (Bread, Orange Marmalade)
Egg Salad 138 2.8 Egg soup 124 2.7 Boiled Egg 76 0
(Lettuce, Cucumber, Onion, Egg, Sesame dressing) (Whole eggs, Celery, Carrots, Onions, Consomme, Sesame oil, Starch) (Egg, Salt)
Fruit 38 1.3 Fruit 86 3.0 Spaghetti Salad 132 2.4
(Pineapple) (Banana) (Spaghetti, Cabbage, Cucumber, Onion, Carrot, Mayonnaise)
Milk 121 0.3 Milk 121 0.3 Fruit 86 3.0
(Milk) (Milk) (Banana)
Breakfast subtotal 493 7.0 Breakfast subtotal 527 8.6 Milk 121 0.3
(Milk)
Lunch Lunch Breakfast subtotal 611 8.3
Rice 322 23.3 Rice 322 23.3
(Rice (polished)) (Rice (polished)) Lunch
Swordfish with Ginger and Soy Sauce 232 114.3 Deep-fried Chicken with Green Beans 189 102.7 Kenchin udon 408 96.0
(Swordfish, Wheat flour, Salad oil, Mirin, Ginger, Reduced-sodium soy sauce, Broad beans) (Chicken thighs, Ginger, Cooking sake, Starch, Frying oil, Green beans, Reduced-sodium soy sauce) (Udon, White Radish, Carrots, Chicken thighs, Fried Tofu, Konnyaku, Burdock, Soup stock, Mirin, Reduced-sodium soy sauce, Snow Peas)
Ratatouille 63 17.5 Potato Kinpira 93 6.4 Noodle Sauce, Shichimi Pepper 29 21.4
(Boiled Soybeans, Vegetable mix, Onion, Tomato, Garlic, Olive oil, Consomme) (Potatoes, Red Peppers, Salad oil, Sugar, Reduced-sodium soy sauce, Sesame oil) (Noodle Soup, Dashi stock, Bonito powder, Shishito Pepper)
Miso soup 28 22.9 Two-color dipping 14 21.5 Tossed with ponzu sauce 68 30.2
(White Miso, Bean sprouts, Dashi stock) (Spinach, Chinese Cabbage, Reduced-sodium soy sauce, Dashi stock, Bonito flakes) (Chinese Cabbage, Mitsuba, Canned Tuna, Ponzu Sauce)
Fruit 31 1.6 Lunch subtotal 618 153.9 Shiratama Zenzai 178 17.9
(Apple) (Shiratama Dumplings, Red Beans, Sugar, Salt)
Lunch subtotal 676 179.6 Lunch subtotal 683 165.5
Dinner Dinner Dinner
Rice 322 23.3 Rice 322 23.3 Rice 322 23.3
(Rice (polished)) (Rice (polished)) (Rice (polished))
Tofu and Beef 224 90.2 Beef Curry 283 95.3 Salmon Meuniere with Potato & Lemon 186 148.5
(Grilled tofu, Beef thigh, Onion, Parsley, Dashi stock, Cooking sake, Mirin, Reduced-sodium soy sauce, Chrysanthemum) (Beef thigh, Garlic, Ginger, Onion, Carrot, Butter, Salt, Curry powder, Canned Tomatoes, Red Wine, Worcestershire sauce, Fukujinzuke) (Salmon, White cooking Wine, Flour, Salad oil, Butter, Potatoes, Dried Parsley, Lemon)
Pumpkin Salad 92 34.5 Pickles 27 26.4 Lotus Root Kinpira 99 12.3
(Pumpkin, Onion, Mayonnaise) (Celery, Cucumber, Cauliflower, Red Pepper, Vinegar, Sugar) (Lotus Root, Ground Beef, Sesame oil, Mirin, Sugar, Reduced-sodium soy sauce)
Radish tossed in Yukari Sauce 23 8.6 Chinese dessert 78 1.0 Cucumber and Seaweed Vinegared Dish 17 8.1
(White Radish, Cucumber, Bamboo, Chikuwa, Yukari) (Canned Chinese Dessert, Canned Fruit Cocktail, Canned Syrup) (Mozuku Seaweed, Cucumber, Salt, Ginger, Sugar, Vinegar)
Dinner subtotal 661 156.6 Dinner subtotal 710 146.0 Dinner subtotal 624 192.3
Daily total 1830 343.2 Daily total 1855 308.5 Daily total 1918 366.1

Table 3.

My Plate Plan diet.

Recipe 1 Recipe 2 Recipe 3
Breakfast Energy
(kcal)
Purine
(mg)
Breakfast Energy
(kcal)
Purine
(mg)
Breakfast Energy
(kcal)
Purine
(mg)
Serial 198 18.2 Tomato Risotto with Oatmeal and Beans 231 62.3 Acai Bowl 450 101.7
(Corn flakes) (Oatmeal, Kidney beans, Onions, Broccoli, Tomato juice, Low-fat milk, Consommé, Olive oil) (Acai, Nonfat yogurt, Banana, Strawberry, Blueberry, Granola, Honey)
Chickpea Salad 295 37.3 Frozen Yogurt 165 9.6 Egg Salad 183 6.5
(Cucumber, Lettuce, Cherry tomato, Onion, Sweet potato (steamed), Chickpeas, Olive oil, Lemon juice) (Fat-free yogurt, Honey, Strawberries) (Boiled egg, Cucumber, Lettuce, Cherry tomato, Olive oil, Salt, Black pepper)
Yogurt 92 10.5 Breakfast subtotal 397 71.9 Breakfast subtotal 633 108.2
(Fat free yogurt, Raspberries, Blueberries)
Breakfast subtotal 585 66.0
Lunch Lunch Lunch
Rye Sandwich 343 57 Bagel Sandwich 625 15.8 Tuna Sandwich 446 69.5
(Rye bread, Chicken (thigh, skinless, boiled), Leaf lettuce, Tomato, Cream cheese, Black pepper) (Bagel, Fried egg, Avocado, Lettuce, Mayonnaise, Pepper) (Bread, Tuna, Onion, Lettuce, Tomato, Mayonnaise, Pepper)
Fruit 148 4.6 Clam Chowder 249.6 87.7 Minestrone 105 13.5
(Apple, Pineapple, Grapes) (Clams (boiled), Bacon, Onion, Potato, Carrot, Flour, Low-fat milk, Salted butter, Pepper, Parsley) (Carrots, Onions, Potatoes, Tomatoes, Cabbage, Canned green peas, Macaroni, Consommé, Parsley)
Cafe Latte 72 0.2 Lunch subtotal 875 103.5 Soy Latte 74 30.1
(Coffee, Low-fat milk) (Coffee, Soy milk)
Lunch subtotal 563 61.9 Lunch subtotal 625 113.1
Dinner Dinner Dinner
Seafood Doria 562 160.4 Bread 196 4.5 Garlic Toast 267 6.25
(Indica rice, Shrimp, Scallops, Squid, Onion, Spinach, Flour, Low-fat milk, Salted butter, Pepper, Breadcrumbs, Processed cheese, Parsley) (Whole Wheat Bread) (Whole wheat bread, Garlic, Butter, Parsley)
Kale Salad 122 20.4 Salmon and Grilled Vegetables with Dill Yogurt Sauce 299 131.6 Pork and Beans 121 34.7
(Kale, Lettuce, Green pepper, Red pepper, Yellow pepper, Almonds (unsalted), Olive oil, Apple cider vinegar, Salt, Pepper) (Salmon, Olive oil, Red pepper, Yellow pepper, Pumpkin, Dill, Nonfat yogurt, Salt, Pepper) (Pork, Onion, Carrot, Pepper, Tomato puree, Garlic, Kidney beans, Salad oil, Chili powder, Consommé)
Dinner subtotal 684 180.8 Fruit and Quinoa Salad 243 23.5 Avocado Salad 185 45.1
(Lettuce, Celery, Quinoa, Orange, Grapefruit, Apple, Kiwi, Olive oil, Salt, Black pepper) (Avocado, Chicken (Thigh, Skinless, Boiled), Lettuce, Tomato, Cottage Cheese, Cilantro, Lemon Juice, Salt, Pepper)
Dinner subtotal 738 159.6 Mango Smoothie 101 10.1
(Mango, Nonfat yogurt)
Dinner subtotal 673 96.1
Daily total 1832 308.7 Daily total 2010 335.0 Daily total 1932 317.5

Table 4.

Mediterranean diet.

Recipe 1 Recipe 2 Recipe 3
Breakfast Energy
(kcal)
Purine
(mg)
Breakfast Energy
(kcal)
Purine
(mg)
Breakfast Energy
(kcal)
Purine
(mg)
Almond Chia Porridge 150 15.7 Vegetable Breakfast Bowl 213 9.9 Mediterranean Breakfast Salad 121 56.7
(Almond milk, Chia seeds, Honey, Vanilla extract, Ground cardamom) (Sweet potato, Russet potatoes, Onion, Paprika, Garlic powder, Onion poder, Olive oil, Sriracha sauce, Coconut milk) (Egg, Arugula, Cherry tomato, Cucumber, Avocado, Quinoa, Chopped almond, Chopped herbs, Lemon, Olive oil, Salt, Pepper)
Bread (Whole wheat bread) 226 5.2 Bread (Whole wheat bread) 113 2.6 Breakfast subtotal 121 56.7
Breakfast subtotal 376 20.9 Breakfast subtotal 326 12.5
Snacks Snacks Snacks
Cherry Tomato Bruschetta 100 8.5 Garlic Broccoli Rabe 87 69.3 Citrus Marinated Olives 200 6.4
(Cherry tomato, Chopped herbs, Whole grain bread, Ricotta cheese, Olive oil, Salt, Black pepper) (Broccoli Rabe, Olive oil, Garlic, Red pepper flake, Salt, Black pepper) (Green Olives, Garlic, Orange, Olive oil, Red wine vinegar, Red pepper flake, Ground cumin, Bay leaf)
Lunch Lunch Lunch
Cauliflower and Quinoa 220 72.7 Beans and Rice 224 38.3 Tomato and Millet Mix 222 17.3
(Quinoa, Cauliflower, Onion, Olive oil, Salt, Black pepper, Parsley) (Rice unpolished, Canned Black Beans, Yellow onion, Celery, Garlic, Olive oil, Salt, Pepper, Water) (Millet, Tomato, Onion, Olive oil, Coriander, Chili Paste, Lemon juice, Salt, Pepper)
Mustard Chicken 531 89.9 Balsamic marinated pork loin skillet 309 112.3 Shrimp and Bean Salad 101 101.8
(Chicken breast, Chicken broth, Mustard, Olive oil, Paprika, Garlic powder, Chili Powder) (Pork Tenderloin, Balsamic vinegar, Paprika, Honey, Onion, Zucchini, Garlic, Olive, Basil, Olive oil, Salt, Pepper) (Shrimp, Kidney beans, Onion, Cherry tomato, Lemon peel, Olive oil, Salt, Pepper, Red wine vinegar)
Roasted Brussels Sprouts with Orange 111 4.7 Sautéed Cabbage 117 6.2 Cauliflower with Kale Paste 41 31.6
(Brussels sprouts, Olive oil, Garlic, Orange, Salt) (Cabbage, Onion, Olive oil, Parsley, Lemon Juice, Salt, Pepper) (Cauliflower, Kale, Basil, Olive oil, Garlic, Lemon juice, Salt)
Coconut Tahini Cashew Bars (No-Bake) 161 6.6 Roasted Fruit 60 9.2 Banana Ice Sundae 328 4.5
(Medjool dates, Walnuts, Cashew nuts, Coconut oil, Salt, Cashew Butter, Tahini) (Peach, Blueberry, Cinnamon, Brown sugar) (Banana, Almond milk, Cocoa powder, Hazelnut butter, Vanilla pod powder, Topping)
Lunch subtotal 1023 173.9 Lunch subtotal 710 166.0 Lunch subtotal 692 155.3
Dinner Dinner Dinner
Grilled Halibut 159 118.4 Fish with Tomato Sauce 86 86.0 Lemon-flavored Trout with Caramelized Shallots 344 154.3
(Halibut, Onion, Green pepper, Chicken stock, Olive oil, Cherry tomato) (Codfish, Cherry tomato, Garlic, Chicken stock, Basil, Salt, Pepper) (Trout(Salmon), Almond butter, Capers, Lemon juice, Lemon, Salt, Pepper, Almond butter, Onion)
Vegetable with Avocado Dressing 403 47.8 Roasted Acorn Squash with Sage 188 10.4 Paprika and Chive Potato Chips 233 18.8
(Roasted pepitas, coriander, Parsley, Corn, White radish, Avocado, Greek Yogurt, Mango, Balsamic vinegar, Olive oil, Lime juice) (Acorn squash, Sage, Thyme, Olive oil, No-salt Butter, Salt, Black pepper) (Potato, Olive oil, Celery, Tomato, Paprika, Salt, Pepper, Chive)
Bread (Whole wheat bread) 226 5.2 Bread (Whole wheat bread) 113 2.6 Bread (Whole wheat bread) 113 2.6
Dinner subtotal 788 171 Dinner subtotal 387 98.9 Dinner subtotal 690 175.6
Daily total 2287 374.7 Daily total 1510 346.6 Daily total 1703 394.0

Table 5.

DASH diet.

Recipe 1 Recipe 2 Recipe 3
Breakfast Energy
(kcal)
Purine
(mg)
Breakfast Energy
(kcal)
Purine
(mg)
Breakfast Energy
(kcal)
Purine
(mg)
The Amazing Feta Hash 303 8.7 Peaches and Greens Smoothie 105 20.9 Sausage Casserole 74 36.3
(Hash browns, Low-fat feta (cheese), Eggs, Soy milk, Onion, Olive oil) (Peaches, Spinach, Low-fat milk, low fat Greek yogurt, No-calorie seetener) (Eggs, Onion, Sausage, Baby potatoes, Chili pepper, Olive oil)
Bread (Whole wheat bread) 113 2.6 Bread (Rye bread) 151 3.4 Bread (Whole wheat bread) 226 5.2
Breakfast subtotal 416 11.3 Breakfast subtotal 256 24.3 Breakfast subtotal 300 41.4
Snacks Snacks Snacks
Salmon and Spinach Salad 155 107.4 Pumpkin & Garlic Soup 234 81.9 Minty Tapenade 180 23.1
(Salmon, Lime, Spinach, Fat-free yogurt, Onion, Capers) (Pumpkin, Onion, Garlic, Vegetable stock, Coconut cream, Almond butter, Ginger) (Black olives, Mint, Avocado oil, Coconut cream)
Lunch Lunch Lunch
Lentil Medley 225 35.6 Veggie Pita Rolls 334 28.5 Roasted Kabocha with Wild Rice 250 64.2
(Lentils, Onion, Mushrooms, Potato, Toato, Cucumber, Spinach, Fresh mint, Honey, Fice vinegar, Olive oil) (Whole-wheat pita breads, Lettuce, Cucumber, Tomato, Onion, Hummus, Bell pepper, Bell pepper, Olive oil, Lime juice) (Kabocha squash, Wild Rice, Pumpkin seeds, Pomegranate seeds, Parsley, Lime juice, Honey, Lime zest, Olive oil, Chili powder, Pepper)
Bread (Whole wheat bread) 226 5.2 Lunch subtotal 334 28.5 Bread (Whole wheat bread) 113 2.6
Lunch subtotal 451 40.7 Lunch subtotal 363 66.7
Snacks Snacks Snacks
Italian Style Mushroom Mix 96 42.6 Sour Cream Green Beans 360 20.4 Honey Sage Carrots 217 1.8
(Mushroom, Onion, Tomato sause, Olive oil, Italian seasoning) (Green Beans, Corn, Mushroom, Cream of mushroom soup, Low-fat sour cream, Almonds, Low-fat cheddar cheese) (Carrots, Honey, Butter, Fresh sage)
Dinner Dinner Dinner
Shallot and Salmon Mix 369 143.8 Chicken with Tomatoes and Celery Stalk 265 335.4 Garlic Pork 344 187.6
(Salmon fillets, Shallot, Olive oil, Parsley) (Chickedn breast, Celery, Tomato, Onion, Zucchini, Mushroom, Garlic, Olive oil) (Pork chop, Onion, Potato, Olive oil, Sweet paprika, Garlic powder, Salt )
Bread (Whole wheat bread) 226 5.2 Bread (Rye bread) 151 3.4 Bread (Whole wheat bread) 226 5.2
Dinner subtotal 595 148.9 Dinner subtotal 416 338.8 Dinner subtotal 570 192.8
Daily total 1713 350.9 Daily total 1600 493.9 Daily total 1630 325.9

4. Discussion

Gout and hyperuricemia are related to lifestyle habits, as the Japanese Guidelines for the Treatment of Hyperuricemia and Gout recommends lifestyle advice. Lifestyle advice includes dietary therapy, alcohol restriction, and exercise recommendations. Within this dietary therapy it recommends appropriate energy intake, avoidance of excessive intake of purine and fructose, and appropriate drinking of water according to renal function are recommended [5]. However, there is little information available regarding the daily intake of purine, making it difficult to visualize.

Thus, in this study, we summarized the purine content of commonly used food ingredients (Table 1), created an illustration based on the Japanese Food Guide Spinning Top (Figure 4), and calculated the amount of purine in well-balanced diets, including the Mediterranean diet and the DASH diet (Table 2, Table 3, Table 4 and Table 5).

The amount of purine across these recipes and in the image diagram in Figure 4 ranged from 308.5 to 493.9 mg/day. A recipe that used a lot of chicken had more than 400 mg. The amount of purine will vary depending on the ingredients used even in a well-balanced diet. By consuming 80–100 g of meat or fish per meal that contains high purine and protein, the amount of purine in well-balanced diet is thought to be around 400 mg/day.

The energy intake of these recipes ranged from 1510 to 2287 kcal, showing considerable variation. When comparing purines and energy across these recipes, the correlation is not clear. The energy of food depends on its fat and carbohydrate content, while purines are correlated with cell number.

Most gouty patients are men, and the recommended daily energy intake based on the average age, height, and weight of gouty patients is about 2200 kcal. If the energy intake in Japanese diet (Table 2) is increased to 2200 kcal and the amount of purine is also increased, the amount of purine in Japanese diet will be 365.9–419.9 mg. Similarly, in the My Plate Plan diet (Table 3), the amount of purine in that will be 361.6–370.7 mg. In the case of the Mediterranean diet (Table 4) and the DASH diet (Table 5), the amount of purine in them will be 360.5–509.0 mg and 439.9–679.1 mg, respectively. The Mediterranean diet and the DASH diet have a slightly higher purine content (converted a daily calorie intake to 2200 kcal), but these recipes contain many low-calorie ingredients. Since energy and purine are not directly correlated, it may not be meaningful to convert them to 2200 kcal and compare them. In any case, a balanced diet is believed to provide adequate energy and purine amount by following the ingredients and frequency recommended in the guidelines.

Regarding the purine content of commonly used ingredients (Table 1), as there are a few tables reporting purine content in foodstuffs, it is hoped that this table will be useful on providing dietary advice not only for patients with gout and hyperuricemia but also for the general public. There are still several ingredients that are lacking, so it is necessary to increase the number of foods and continue measuring them.

Figure 4 represents “A well-balanced diet based on the Japanese Food Guide Spinning Top”. This illustration is designed to allow users to present a diagram for intuitive understanding, and we hope that many people will find it useful.

We selected four dietary guidelines for determining purine content: the Japanese Food Guide diet, the My Plate Plan diet, the Mediterranean diet, and the DASH diet [23,24,25,26,27,28,29,30]. The reason is that these dietary guidelines are promoted as healthy diets by government agencies involved in national health of countries with many patients with gout and hyperuricemia, and the Mediterranean diet and the DASH diet have been reported to be effective for patients with gout and hyperuricemia [3,14,15,16,17,18]. Although it would have been better to refer to other dietary guidelines, we focused on these because well-balanced diets are well thought out and are considered to not vary significantly with each other.

This study has two features. The first is that we provide a list of the purine content of commonly used foodstuffs. We have been continuously measuring purine content, and a table compiling the data are useful (Table 1). The second is that we calculate the daily amount of purine contained in a generally recommended balanced diet. The balanced diet described in the Dietary Guidelines contains approximately 400 mg/day of purine. It is known that a high purine diet increases serum uric acid levels and increases the recurrence rate of gout attacks. A well-balanced diet is recommended not only to the general public but also to patients with gout and hyperuricemia.

There are two limitations to this study. The first is that there is still a lack of data on the purine content of foodstuffs. Further measurements are planned. The second is that the dietary guidelines used in this study were limited to four guidelines, not those from around the world. The reason for this was mentioned above, but another reason is that it was difficult to obtain foodstuffs from overseas, making it difficult to measure the purine content in them.

In the future, we plan to obtain various foodstuffs from around the world via the Internet and other means, measure the purine content in them, and use the results to provide dietary advice to patients with gout and hyperuricemia.

5. Conclusions

After creating recipes based on the dietary guidelines and calculating the amount of purine, the purine amount in the Japanese diet, the American My Plate Plan, the Mediterranean diet, and the DASH diet were found to be 308.5–493.9 mg/day. The diets examined in this study, the daily amount of purine did not exceed 400 mg/day, except for a recipe that included 200 g of chicken. A well-balanced diet following the recommendation of the dietary guidelines is considered to contain an adequate amount of purine, around 400 mg/day. Because a high purine diet can lead to the recurrence of gout, advising to eat a balanced diet should be useful lifestyle guidance for patients with gout and hyperuricemia.

Acknowledgments

We would like to thank Nishizawa (President of Biomolecular Logic Research Laboratory) for reading the manuscript and giving us advice on revising it. We would also like to thank Hiratsuka who cooperated with the purine measurements.

Author Contributions

Conceptualization, K.K. and S.F.; methodology, T.F. and N.Y.; validation, K.K. and K.T.; formal analysis, R.S., investigation, K.T. and F.T.; resources, K.T. and T.F.; writing—original draft preparation, K.K.; writing—review and editing, T.F., F.T. and R.S.; visualization, F.T.; supervision, N.Y. and S.F. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

Author Keito Tsuruga was employed by the company FORALL Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding Statement

This study was supported by Research Grant C (0040635) of the Laboratory of Biomedical and Analytical Sciences, Faculty of Pharmaceutical Sciences, Teikyo University.

Footnotes

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.


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