medwireNews: Research suggests that around three-quarters of incident gout cases could be prevented by modifying weight, diet, use of diuretics, and alcohol consumption.
However, the researchers point out in JAMA Network Open that individuals who are obese “may not benefit from other modifications unless weight loss is addressed.”
The team analyzed data for 44,654 men, aged a mean of 54 years, from the US-based Health Professionals Follow-up Study who completed a questionnaire pertaining to their medical history, current diet, and lifestyle habits every 2 years from 1986 to 2012.
None of the men had gout at baseline, but 3.9% developed confirmed cases during the 26-year follow-up.
The researchers note that excess adiposity was the greatest predictor for developing gout. Obese men (BMI ≥30 kg/m2) were a significant 2.65 times more likely to develop the condition than men at the lower limit of normal weight (BMI <23 kg/m2). Patients who were overweight (25.0–29.9 kg/m2) and at the upper limit of normal weight (23.0–24.9 kg/m2) also had a significantly increased risk, with corresponding relative risks (RRs) of 1.90 and 1.29.
Other risk factors for gout included diuretic use, which significantly increased the risk 2.10-fold, compared with no use, and alcohol consumption, with men who consumed at least 5 g/day of alcohol at significantly higher risk than those who abstained, with RRs increasing from 1.20 to 2.10 depending on the amount of alcohol consumed (5.0 to ≥30.0 g/day).
Patients who were assigned a high DASH dietary pattern score (fifth quintile) – indicative of greater consumption of fruit, vegetables, and low-fat dairy products and lower consumption of red and processed meats and sweetened beverages – were significantly less likely to develop gout than patients with a lower score (first quintile), with an RR of 0.74.
Hyon Choi (Harvard Medical School, Boston, Massachusetts, USA) et al say that 77% of the 1741 cases of gout could have been avoided if the study participants had a BMI below 25 kg/m2, followed the DASH diet, and did not take diuretics or drink alcohol. This number could increase to 79% if the men had a BMI below 23 kg/m2.
Among the normal weight (BMI <25 kg/m2) and overweight men, over half (69% and 59%, respectively) could have theoretically avoided gout if they had followed the DASH diet, abstained from alcohol, and not taken diuretics.
But, in obese men, modifying these factors would only be expected to avoid a nonsignificant 5% of incident gout cases, “suggesting that for the risk of gout, men with obesity may not benefit from the other modifications unless weight is also addressed,” Choi and co-authors say. They therefore emphasize the “prominent role of diet and exercise, through modifying BMI, on the risk of gout at the population level.”
The study investigators conclude that “these data generated from male health professionals may not apply to the general population.”
“However, as the risk factors for gout tend to be more common in the general population, the magnitude of the risk reduction would probably be even greater than that observed in this study.”
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JAMA Netw Open 2020; 3: e2027421