medwireNews: Adherence to one of four healthy eating patterns recommended in the 2020 to 2025 Dietary Guidelines for Americans is associated with a reduced risk for gout in women, Nurses’ Health Study findings indicate.
Conversely, strong adherence to a Western diet, characterized by higher intake of red and processed meats, refined grains, sweets, desserts, and high-fat dairy, is associated with an increased gout risk, report Natalie McCormick (Harvard Medical School, Boston, Massachusetts, USA) and co-authors in JAMA Internal Medicine.
The say: “Female-specific gout data are scarce despite perceived differences from males in its risk factors and disproportionate worsening in disease and comorbidity burden globally.”
To address this, McCormick and team used food frequency questionnaire responses, collected from 80,039 US women in the Nurses’ Health Study every 4 years between 1984 and 2018, to generate scores for four healthy eating patterns: Dietary Approaches to Stop Hypertension (DASH), Prudent, Alternative Healthy Eating Index (AHEI), and Mediterranean Diet, along with the Western pattern, which acted as an unhealthy comparison.
During 34 years of follow-up, 3890 women developed gout.
After adjustment for variables including age, menopause, medication use, and dietary factors, the researchers found that women most adherent (top quintile) to the healthy diets had significantly lower risks for gout than those who were least adherent.
Specifically, the risk reduction was 32% for the highest versus lowest quintile of DASH adherence, 25% for Prudent, 21% for AHEI, and 12% for the Mediterranean diet.
“Furthermore, these findings largely persisted in subgroups according to diuretic use, BMI, and alcohol intake, all strong risk factors for gout whose frequencies, we found, differ substantially from men,” McCormick et al remark.
At the time of gout diagnosis, 43% of women were using diuretics, 41% were obese, and 52% consumed alcohol.
In combined analyses, the most DASH-diet adherent women with normal BMI (<25 kg/m2) had a significant 68% lower risk for gout than the least adherent women with an overweight or obese BMI (>25 kg/m2). The corresponding risk reduction was a significant 65% when high DASH adherence was combined with no diuretic use, and there was a similar trend for the other three types of healthy diet. There was no notable combined effect when alcohol use was considered alongside diet, however.
On the other hand, individuals most adherent to a Western diet had a significant 1.5-fold higher risk for gout relative to those least adherent, and when this style of diet was combined with diuretic use or raised BMI, the risk was 3.0–3.5-fold higher.
McCormick and colleagues suggest that the “guideline-based diets likely affect gout risk through 2 key shared mechanisms involving insulin resistance and inflammation.” They say that regardless of the mechanisms, their “findings show the 4 healthy dietary patterns, congruent with the latest Dietary Guidelines for Americans with known cardiovascular- metabolic health benefits, also have the potential to simultaneously lower the risk of gout among women.”
They add: “The identification of multiple patterns of eating that can similarly reduce a woman’s risk of incident gout in our study allows more choice for potential personalization of dietary recommendations according to culinary traditions and personal preferences (including a genetic predisposition component), to enhance adherence, as well as comorbidity status (eg, DASH pattern for women with existing hypertension).”
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