Intervenciones en el estilo de vida para la gota crónica
Appendices
Appendix 1. CENTRAL search strategy
#1 MeSH descriptor Gout explode all trees
#2 gout*:ti,ab
#3 (#1 OR #2)
#4 MeSH descriptor Ethanol explode all trees
#5 ethanol:ti,ab
#6 MeSH descriptor Alcohol‐Related Disorders explode all trees
#7 MeSH descriptor Alcohol Drinking, this term only
#8 alcohol*:ti,ab
#9 MeSH descriptor Exercise explode all trees
#10 MeSH descriptor Exercise Therapy explode all trees
#11 MeSH descriptor Exercise Movement Techniques explode all trees
#12 MeSH descriptor Physical Education and Training explode all trees
#13 MeSH descriptor Physical Fitness, this term only
#14 MeSH descriptor Physical Exertion, this term only
#15 MeSH descriptor Sports explode all trees
#16 exercis*:ti,ab
#17 sport*:ti,ab
#18 (physical* next (fit* or exert* or activ*)):ti,ab
#19 (run* or jog* or walk*):ti,ab
#20 (swim* or cycl* or bicycl*):ti,ab
#21 train*:ti,ab
#22 kinesi?therap*:ti,ab
#23 ((weight or muscle*) next (strength* or resistance)):ti,ab
#24 endurance:ti,ab
#25 MeSH descriptor Tobacco explode all trees
#26 MeSH descriptor Tobacco Use Disorder, this term only
#27 MeSH descriptor Tobacco Use Cessation explode all trees
#28 MeSH descriptor Tobacco Smoke Pollution explode all trees
#29 MeSH descriptor Nicotine, this term only
#30 smok*:ti,ab
#31 (cigarette* or cigar* or pipe*):ti,ab
#32 (#4 OR #5 OR #6 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31)
#33 MeSH descriptor Weight Loss explode all trees
#34 weight loss:ti,ab
#35 (weight near/2 (lo* or reduc* or eliminat*)):ti,ab
#36 ((body mass index or bmi) near/3 (los* or reduc* or decreas* or low*)):ti,ab
#37 (Waist circumference near/2 (reduc* or low* or small*)):ti,ab
#38 (Waist size near/2 (reduc* or low* or small*)):ti,ab
#39 energy next restrict*:ti,ab
#40 (calor* near/2 (restrict* or reduc* or low*)):ti,ab
#41 MeSH descriptor Anti‐Obesity Agents explode all trees
#42 (appetite near/2 suppress*):ti,ab
#43 orlistat:ti,ab
#44 xenical:ti,ab
#45 alli:ti,ab
#46 tetrahydrolipstatin:ti,ab
#47 phentermine:ti,ab
#48 phenyl‐tertiary‐butylamine:ti,ab
#49 Ionamin:ti,ab
#50 adipex‐P:ti,ab
#51 anoxine‐AM:ti,ab
#52 duromine:ti,ab
#53 metermine:ti,ab
#54 mirapront:ti,ab
#55 obephen:ti,ab
#56 obestin‐30:ti,ab
#57 phentremene:ti,ab
#58 phentrol:ti,ab
#59 phenterex:ti,ab
#60 phentromin:ti,ab
#61 "pro‐fast SA":ti,ab
#62 redusa:ti,ab
#63 panbesy:ti,ab
#64 "phentermine trenker":ti,ab
#65 Obenix:ti,ab
#66 Oby‐trim:ti,ab
#67 Teramine:ti,ab
#68 Zantryl:ti,ab
#69 Sinpet:ti,ab
#70 Supremin:ti,ab
#71 Umine:ti,ab
#72 Weltmine:ti,ab
#73 Aplenzin:ti,ab
#74 (#33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46 OR #47 OR #48 OR #49 OR #50 OR #51 OR #52 OR #53 OR #54 OR #55 OR #56 OR #57 OR #58 OR #59 OR #60 OR #61 OR #62 OR #63 OR #64 OR #65 OR #66 OR #69 OR #70 OR #71 OR #72 OR #73)
#75 MeSH descriptor Diet explode all trees
#76 diet*:ti,ab
#77 MeSH descriptor Nutrition Therapy explode all trees
#78 (lacto‐vegetarian* or lacto vegetarian* or vegetarian* or non‐vegetarian*):ti,ab
#79 non near/2 vegetarian*:ti,ab
#80 vegan*:ti,ab
#81 (Cretan or Mediterranean):ti,ab
#82 MeSH descriptor Fasting, this term only
#83 fast*:ti,ab
#84 (protein near/2 (restrict* or reduc* or low* or elim*)):ti,ab
#85 (purine near/2 (restrict* or reduc* or low* or elim*)):ti,ab
#86 (fat near/2 (restrict* or reduc* or low* or elim)):ti,ab
#87 (triglyceride near/2 (restrict* or reduc* or low* or elim*)):ti,ab
#88 (cholesterol near/2 (restrict* or reduc* or low* or elim*)):ti,ab
#89 (diet near/3 (reduc* or low* or restrict* or elim*)):ti,ab
#90 (#75 OR #76 OR #77 OR #78 OR #78 OR #79 OR #80 OR #81 OR #82 OR #83 OR #84 OR #85 OR #86 OR #87 OR #88 OR #89)
#91 MeSH descriptor Dairy Products explode all trees
#92 (milk or cheese* or yog?urt or dairy):ti,ab
#93 MeSH descriptor Milk, this term only
#94 MeSH descriptor Cultured Milk Products, this term only
#95 (#91 OR #92 OR #93 OR #94)
#96 MeSH descriptor Sucrose explode all trees
#97 MeSH descriptor Fructose, this term only
#98 (sucrose* or lactose* or glucose* or fructose* or glycerine* or lycerine* or dextrose* or aspartame* or polycose* or sacchar* or sugar*):ti,ab
#99 (sweet* near/6 (solution* or tast*)):ti,ab
#100 (Diet* near/3 (drink* or beverage*)):ti,ab
#101 (soft near/2 (drink* or beverage*)):ti,ab
#102 (soda or sodas):ti,ab
#103 (#96 OR #97 OR #98 OR 99 OR #100 OR #101 OR #102)
#104 MeSH descriptor Coffee, this term only
#105 MeSH descriptor Caffeine, this term only
#106 (coffee or caffiene or caffeinated or decaffeinated):ti,ab
#107 (#104 OR #105 OR #106)
#108 MeSH descriptor Life Style explode all trees
#109 (life near/2 (style* or change$*or event*)):ti,ab
#110 lifestyle*:ti,ab
#111 MeSH descriptor Social Support, this term only
#112 "social support":ti,ab
#113 MeSH descriptor Relaxation explode all trees
#114 MeSH descriptor Relaxation Therapy, this term only
#115 relax*:ti,ab
#116 MeSH descriptor Self Efficacy, this term only
#117 (self next (efficac* or help or manag* or care)):ti,ab
#118 MeSH descriptor Health Promotion explode all trees
#119 MeSH descriptor Health Education explode all trees
#120 (health next (promot* or educat*)):ti,ab
#121 (motivat* next (therap* or interview*)):ti,ab
#122 (#108 OR #109 OR #110 OR #111 OR #112 OR #113 OR #114 OR #115 OR #115 OR #116 OR #117 OR #118 OR #119 OR #120 OR #121)
#123 (#32 OR #74 OR #90 OR #95 OR #107 OR #122)
#124 (#3 AND #123)
Appendix 2. MEDLINE search strategy
1. exp gout/
2. gout$.tw.
3. 1 or 2
4. exp life style/
5. (life adj2 (style$ or change$ or event$)).tw.
6. lifestyle$.tw.
7. social support/
8. social support.tw.
9. exp relaxation/ or relaxation therapy/
10. relax$.tw.
11. self efficacy/
12. (self adj (efficac$ or help or manag$ or care)).tw.
13. exp health promotion/
14. exp health education/
15. (health adj (promot$ or educat$)).tw.
16. (motivat$ adj (therap$ or interview$)).tw.
17. or/4‐16
18. exp Weight Loss/
19. weight loss.tw.
20. (weight adj2 (lo$ or reduc$ or eliminat$)).tw.
21. ((body mass index or bmi) adj3 (los$ or reduc$ or decreas$ or low$)).tw.
22. (Waist circumference adj2 (reduc$ or low$ or small$)).tw.
23. (Waist size adj2 (reduc$ or low$ or small$)).tw.
24. energy restrict$.tw.
25. (calor$ adj2 (restrict$ or reduc$ or low$)).tw.
26. exp Anti‐Obesity Agents/
27. (appetite adj2 suppress$).tw.
28. orlistat.tw.
29. xenical.tw.
30. alli.tw.
31. tetrahydrolipstatin.tw.
32. phentermine.tw.
33. phenyl‐tertiary‐butylamine.tw.
34. Ionamin.tw.
35. adipex‐P.tw.
36. anoxine‐AM.tw.
37. duromine.tw.
38. metermine.tw.
39. mirapront.tw.
40. obephen.tw.
41. obestin‐30.tw.
42. phentremene.tw.
43. phentrol.tw.
44. phenterex.tw.
45. phentromin.tw.
46. pro‐fast SA.tw.
47. redusa.tw.
48. panbesy.tw.
49. phentermine trenker.tw.
50. Obenix.tw.
51. Oby‐trim.tw.
52. Teramine.tw.
53. Zantryl.tw.
54. Sinpet.tw.
55. Supremin.tw.
56. Umine.tw.
57. Weltmine.tw.
58. Aplenzin.tw.
59. or/18‐58
60. exp diet/
61. diet$.tw.
62. exp Nutrition Therapy/
63. (lacto‐vegetarian$ or lacto vegetarian$ or vegetarian$ or non‐vegetarian$).tw.
64. (non adj2 vegetarian$).tw.
65. vegan$.tw.
66. (Cretan or Mediterranean).tw.
67. Fasting/
68. fast$.tw.
69. (protein adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
70. (purine adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
71. (fat adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
72. (triglyceride adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
73. (cholesterol adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
74. (diet adj3 (reduc$ or low$ or restrict$ or elim$)).tw.
75. or/60‐74
76. exp Dairy Products/
77. (milk or cheese$ or yog?urt or dairy).tw.
78. milk/ or cultured milk products/
79. or/76‐78
80. exp Sucrose/
81. Fructose/
82. (sucrose$ or lactose$ or glucose$ or fructose$ or glycerine$ or lycerine$ or dextrose$ or aspartame$ or polycose$ or sacchar$ or sugar$).tw.
83. (sweet$ adj6 (solution$ or tast$)).tw.
84. (Diet$ adj3 (drink$ or beverage$)).tw.
85. (soft adj2 (drink$ or beverage$)).tw.
86. (sugar adj2 free adj2 (drink$ or beverage$)).tw.
87. (soda or sodas).tw.
88. or/80‐87
89. Coffee/
90. Caffeine/
91. (coffee or caffiene or caffeinated or decaffeinated).tw.
92. or/89‐91
93. exp Ethanol/
94. ethanol.tw.
95. exp Alcohol‐Related Disorders/
96. Alcohol Drinking/
97. alcohol$.tw.
98. or/93‐97
99. exp exercise/
100. exp Exercise Therapy/
101. exp Exercise Movement Techniques/
102. exp "Physical Education and Training"/
103. Physical Fitness/
104. Physical Exertion/
105. exp sports/
106. exercis$.tw.
107. sport$.tw.
108. (physical$ adj (fit$ or exert$ or activ$)).tw.
109. (run$ or jog$ or walk$).tw.
110. (swim$ or cycl$ or bicycl$).tw.
111. train$.tw.
112. kinesi?therap$.tw.
113. ((weight or muscle$) adj (strength$ or resistance)).tw.
114. endurance$.tw.
115. or/99‐114
116. exp Tobacco/
117. "Tobacco Use Disorder"/
118. exp "Tobacco Use Cessation"/
119. Tobacco Smoke Pollution/
120. Nicotine/
121. smok$.tw.
122. (cigarette$ or cigar$ or pipe$).tw.
123. Nicotinic Agonists/
124. (nicotine adj (replacement or patch$ or gum or nasal)).tw.
125. nrt.tw.
126. nicorette.tw.
127. Nicotrol.tw.
128. Nicoderm$.tw.
129. Habitrol.tw.
130. Bupropion/
131. Bupropion.tw.
132. Amfebutamone.tw.
133. Aplenzin.tw.
134. Budeprion.tw.
135. Buproban.tw.
136. Butrew.tw.
137. Buxon.tw.
138. champix.tw.
139. Clorprax.tw.
140. Dosier.tw.
141. Elontril.tw.
142. Mondrian.tw.
143. Nicotex.tw.
144. Prexaton.tw.
145. Quomem.tw.
146. Voxra.tw.
147. Wellbutrin.tw.
148. Zetron.tw.
149. Zyban.tw.
150. Zyntabac.tw.
151. varenicline.tw.
152. exp hypnosis/
153. hypno$.tw.
154. exp counseling/
155. counsel$.tw.
156. or/116‐155
157. or/17,59,75,79,88,92,98,115,156
158. 3 and 157
159. randomized controlled trial.pt.
160. controlled clinical trial.pt.
161. randomized.ab.
162. placebo.ab.
163. drug therapy.fs.
164. randomly.ab.
165. trial.ab.
166. groups.ab.
167. or/159‐166
168. (animals not (humans and animals)).sh.
169. 167 not 168
170. 158 and 169
Appendix 3. EMBASE search strategy
1. exp gout/
2. gout$.tw.
3. 1 or 2
4. exp life style/
5. Lifestyle modification/
6. (life adj2 (style$ or change$ or event$)).tw.
7. lifestyle$.tw.
8. Social support/
9. social support.tw.
10. Relaxation training/
11. relax$.tw.
12. Self concept/ or exp self care/
13. (self adj (efficac$ or help or manag$ or care)).tw.
14. Health promotion/
15. exp health education/
16. (health adj (promot$ or educat$)).tw.
17. (motivat$ adj (therap$ or interview$)).tw.
18. 4 or 17
19. weight reduction/
20. (weight adj2 (lo$ or reduc$ or eliminat$)).tw.
21. ((body mass index or bmi) adj3 (los$ or reduc$ or decreas$ or low$)).tw.
22. (Waist circumference adj2 (reduc$ or low$ or small$)).tw.
23. (Waist size adj2 (reduc$ or low$ or small$)).tw.
24. energy restrict$.tw.
25. (calor$ adj2 (restrict$ or reduc$ or low$)).tw.
26. antiobesity agent/
27. (appetite adj2 suppress$).tw.
28. orlistat.tw.
29. xenical.tw.
30. alli.tw.
31. tetrahydrolipstatin.tw.
32. phentermine.tw.
33. phenyl‐tertiary‐butylamine.tw.
34. Ionamin.tw.
35. adipex‐P.tw.
36. anoxine‐AM.tw.
37. duromine.tw.
38. metermine.tw.
39. mirapront.tw.
40. obephen.tw.
41. obestin‐30.tw.
42. phentremene.tw.
43. phentrol.tw.
44. phenterex.tw.
45. phentromin.tw.
46. pro‐fast SA.tw.
47. redusa.tw.
48. panbesy.tw.
49. phentermine trenker.tw.
50. Obenix.tw.
51. Oby‐trim.tw.
52. Teramine.tw.
53. Zantryl.tw.
54. Sinpet.tw.
55. Supremin.tw.
56. Umine.tw.
57. Weltmine.tw.
58. amfebutamone/
59. Aplenzin.tw.
60. Zyban.tw.
61. or/19‐60
62. exp diet/
63. diet$.tw.
64. exp diet therapy/
65. (lacto‐vegetarian$ or lacto vegetarian$ or vegetarian$ or non‐vegetarian$).tw.
66. (non adj2 vegetarian$).tw.
67. vegan$.tw.
68. (Cretan or Mediterranean).tw.
69. fast$.tw.
70. (protein adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
71. (purine adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
72. (fat adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
73. (triglyceride adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
74. (cholesterol adj2 (restrict$ or reduc$ or low$ or elim$)).tw.
75. or/62‐73
76. exp dairy product/
77. (milk or cheese$ or yog?urt or dairy).tw.
78. milk/
79. or/76‐78
80. sucrose/
81. fructose/
82. (sucrose$ or lactose$ or glucose$ or fructose$ or glycerine$ or lycerine$ or dextrose$ or aspartame$ or polycose$ or sacchar$ or sugar$).tw.
83. (sweet$ adj6 (solution$ or tast$)).tw.
84. (Diet$ adj3 (drink$ or beverage$)).tw.
85. (soft adj2 (drink or beverage)).tw.
86. (sugar adj2 free adj2 (drink$ or beverage$)).tw.
87. (soda or sodas).tw.
88. or/80‐87
89. coffee/
90. caffeine/
91. (coffee or caffiene or caffeinated or decaffeinated).tw.
92. or/89‐91
93. alcohol/
94. ethanol.tw.
95. alcoholism/
96. drinking behavior/
97. alcohol$.tw.
98. or/93‐97
99. exp exercise/
100. exp kinesiotherapy/
101. physical education/
102. fitness/
103. exp sports/
104. exercis$.tw.
105. sport$.tw.
106. (physical$ adj (fit$ or exert$ or activ$)).tw.
107. (run$ or jog$ or walk$).tw.
108. (swim$ or cycl$ or bicycl$).tw.
109. train$.tw.
110. kinesi?therap$.tw.
111. ((weight or muscle$) adj (strength$ or resistance)).tw.
112. endurance.tw.
113. or/99‐112
114. tobacco/
115. tobacco dependence/
116. smoking cessation/
117. exp "smoking and smoking related phenomena"/
118. nicotine/
119. smok$.tw.
120. (cigarette$ or cigar$ or pipe$).tw.
121. nicotine replacement therapy/
122. (nicotine adj (replacement or patch$ or gum or nasal)).tw.
123. nrt.tw.
124. nicorette.tw.
125. Nicotrol.tw.
126. Nicoderm$.tw.
127. Habitrol.tw.
128. amfebutamone/
129. Bupropion.tw.
130. Amfebutamone.tw.
131. Aplenzin.tw.
132. Budeprion.tw.
133. Buproban.tw.
134. Butrew.tw.
135. Buxon.tw.
136. champix.tw.
137. Clorprax.tw.
138. Dosier.tw.
139. Elontril.tw.
140. Mondrian.tw.
141. Nicotex.tw.
142. Prexaton.tw.
143. Quomem.tw.
144. Voxra.tw.
145. Wellbutrin.tw.
146. Zetron.tw.
147. Zyban.tw.
148. Zyntabac.tw.
149. varenicline.tw.
150. hypnosis/
151. hypno$.tw.
152. exp counseling/
153. counsel$.tw.
154. or/114‐153
155. or/18,61,75,79,88,92,98,113,154
156. 3 and 155
157. (random$ or placebo$ or single blind$ or double blind$ or triple blind$).ti,ab.
158. RETRACTED ARTICLE/
159. 157 or 158
160. (animal$ not human$).sh,hw.
161. (book or conference paper or editorial or letter or review).pt. not exp randomized controlled trial/
162. (random sampl$ or random digit$ or random effect$ or random survey or random regression).ti,ab. not exp randomized controlled trial/
163. 159 not (160 or 161 or 162)
164. 156 and 163
Study flow diagram.
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Forest plot of comparison: 1 SMP (GMP/G600) versus control (SMP/lactose), outcome: 1.1 Number of gout flares per month, after 3 months SMP (GMP/G600) versus control (SMP/lactose).
Forest plot of comparison: 1 SMP (GMP/G600) versus control (SMP/lactose), outcome: 1.2 Physical Function.
Forest plot of comparison: 1 SMP (GMP/G600) versus control (SMP/lactose), outcome: 1.3 Participant withdrawals due to adverse events.
Comparison 1 SMP (GMP/G600) versus control (SMP/lactose), Outcome 1 Number of gout flares per month, after 3 months SMP (GMP/G600) versus control (SMP/lactose).
Comparison 1 SMP (GMP/G600) versus control (SMP/lactose), Outcome 2 Physical Function.
Comparison 1 SMP (GMP/G600) versus control (SMP/lactose), Outcome 3 Participant withdrawals due to adverse events.
| Skim milk enriched with GMP/G600 compared to skim milk & lactose powder for chronic gout | ||||||
| Patient or population: patients with chronic gout | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Skim milk & lactose powder | Skim milk enriched with GMP/G600 | |||||
| Acute gout attack frequency | The mean acute gout attack frequency in the control groups was | The mean acute gout attack frequency in the intervention groups was | 120 | ⊕⊕⊝⊝ | Not statistically significant2 | |
| Participant withdrawals due to adverse events | Study population | RR 1.27 | 120 | ⊕⊕⊝⊝ | Not statistically significant3 | |
| 138 per 1000 | 175 per 1000 | |||||
| Moderate | ||||||
| Joint pain reduction | The mean joint pain reduction in the control groups was | The mean joint pain reduction in the intervention groups was | 120 | ⊕⊕⊝⊝ | Absolute risk difference = ‐10% (‐20% to ‐1%). Relative percentage change = ‐39% (‐74% to ‐4%). NNTB = 10 (5 to 100)2 | |
| Tophus regression ‐ not measured | See comment | See comment | Not estimable | ‐ | See comment | Not measured |
| Physical function | The mean physical function in the control groups was | The mean physical function in the intervention groups was | 120 | ⊕⊕⊝⊝ | Absolute risk difference = ‐1% (‐5% to 3%). Relative percentage change = ‐13% (‐58% to 33%) NNT n/a, not statistically significant2 | |
| Serum urate normalisation4 ‐ not reported | See comment | See comment | Not estimable4 | ‐ | See comment | Not reported |
| Serious adverse events | 38 per 1000 | 50 per 1000 | RR 1.33 | 120 | ⊕⊕⊝⊝ | Gastrointestinal AEs (diarrhoea, nausea and flatulence) reported most commonly. SAE related to hospital admissions ‐ none were due to the study products.3 |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 There was selective reporting of post‐hoc comparisons between skim milk powder enriched with GMP/G600 and one of the two study controls (lactose) in relation to change in gout attack frequency from baseline | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of gout flares per month, after 3 months SMP (GMP/G600) versus control (SMP/lactose) Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 2 Physical Function Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3 Participant withdrawals due to adverse events Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
