{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:52:05Z","timestamp":1781765525687,"version":"3.54.5"},"reference-count":49,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Promopharma Srl"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Serum uric acid (UA) is increasingly recognized as a cardiovascular (CV) risk factor, with evidence suggesting that CV risk may occur at levels below conventional hyperuricemia thresholds. However, real-world comparative data on the effects of dietary interventions on UA are limited. Objective: The primary objective of this study was to compare the effects of a very low-calorie ketogenic diet (VLCKD), intermittent fasting (IF), and standard dietary advice (free diet, FD) on UA levels and UA-defined CV risk in hypertensive postmenopausal women. Methods: In this prospective, single-center, real-world clinical study, 43 women with essential hypertension and obesity underwent dietary interventions. UA levels were assessed at baseline and after 6 months. Hyperuricemia was defined using both the conventional threshold (\u22656.0 mg\/dL) and the CV risk-oriented Uric Acid Right for Heart Health (URRAH) cut-off (\u22654.7 mg\/dL). Analyses included paired tests and ANCOVA adjusted for baseline UA. Results: At baseline, over half of participants exceeded the URRAH threshold. Only VLCKD significantly reduced UA levels (\u22121.23 mg\/dL; p &lt; 0.001), remaining independently associated after adjustment (\u03b2 = \u22120.95 mg\/dL; p = 0.007). URRAH-defined CV risk decreased significantly only in the VLCKD group (55.6% to 22.2%), with one-third transitioning to lower risk. Conclusions: VLCKD significantly reduced UA levels and UA-defined CV risk, supporting its role as a potentially effective lifestyle intervention in this population.<\/jats:p>","DOI":"10.3390\/nu18121912","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T03:01:27Z","timestamp":1781492487000},"page":"1912","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Serum Uric Acid as a Cardiovascular Risk Marker: Differential Effects of Ketogenic Diet and Intermittent Fasting in Postmenopausal Women"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7359-4028","authenticated-orcid":false,"given":"Barbara","family":"Pala","sequence":"first","affiliation":[{"name":"Division of Cardiology, Ospedale Istituto Dermopatico dell\u2019Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Via dei Monti di Creta, 104, 00167 Rome, Italy"},{"name":"PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Pennazzi","sequence":"additional","affiliation":[{"name":"Italian Society of Nutraceuticals (SINut), 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2935-2023","authenticated-orcid":false,"given":"Mariagrazia","family":"Piscione","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Campus Bio-Medico, University of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6861-6870","authenticated-orcid":false,"given":"Giulia","family":"Nardoianni","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant\u2019Andrea Hospital 1035\/1039, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Miletti","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant\u2019Andrea Hospital 1035\/1039, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1906-8032","authenticated-orcid":false,"given":"Serena","family":"De Mitri","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ospedale Istituto Dermopatico dell\u2019Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Via dei Monti di Creta, 104, 00167 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-4276","authenticated-orcid":false,"given":"Paola","family":"Gualtieri","sequence":"additional","affiliation":[{"name":"Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8875-6723","authenticated-orcid":false,"given":"Laura","family":"Di Renzo","sequence":"additional","affiliation":[{"name":"Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy"},{"name":"Food Science Fellowship, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Barbato","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant\u2019Andrea Hospital 1035\/1039, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0635-4921","authenticated-orcid":false,"given":"Giuliano","family":"Tocci","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant\u2019Andrea Hospital 1035\/1039, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1056\/NEJM197906283002604","article-title":"Hyperuricemia and Gout","volume":"300","author":"Boss","year":"1979","journal-title":"N. 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