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Dietary Omega-3 Fatty Acids Linked to Lower Risk of Recurrent Gout Flare
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The consumption of dietary omega-3 polyunsaturated fatty acids via fish is associated with a lower risk for gout flares, whereas consuming omega-3s exclusively through self-administered supplements has no effect, according to data published in Arthritis & Rheumatology.
“In addition to optimizing overall gout management with urate-lowering therapy, my research group has an interest in understanding factors that may trigger gout flares and/or reduce the risk of gout flares to gain insights into additional approaches that may be used to reduce the burden of gout flares,” Tuhina Neogi, MD, PhD, FRCPC, of the Boston University School of Medicine, told Healio Rheumatology. “For example, if there are factors that may trigger flares, people with gout may consider limiting their exposure to them. If something may reduce the risk of gout flares, then that may be a preventive strategy to further study for its efficacy.”
“In this particular study, we were interested in examining omega-3 PUFA, such as can be found in certain types of fatty fish and in supplements such as cod liver oil, for their purported anti-inflammatory effects,” she added. “These anti-inflammatory effects may potentially have a beneficial impact on reducing gout flares. Our study design is unique in that each person acts as his/her own control, so that all between-person differences that can typically confound studies of dietary factors with disease outcomes is inherently controlled for.”
To analyze the link between omega-3 polyunsaturated fatty acids and the risk for recurrent gout flares, Zhang and colleagues studied data from the Boston University Online Gout Study, an online, case-crossover survey conducted from 2003 to 2012. The original intent of the survey was to identify risk factors for recurrent gout flares, in which each participant served as their own control as they provided information during both flare and flare-free periods.
Participants completed questionnaires regarding their various exposures, including their diet and alcohol consumption, as well as any self-administered supplements, during the previous 48 hours. Zhang and colleagues evaluated the data for links between self-reported consumption of omega-3 polyunsaturated fatty acids, either through supplements or diet, and the risk for recurring flares. They used conditional logistic regression, adjusting for total purine consumption, diuretic use and other urate-lowering or flare prophylactic medications. A total of 724 participants completed the online study.
According to the researchers, 85% of participants fulfilled the 1977 preliminary American College of Rheumatology classification criteria for acute gout, and 22% had reported consuming omega-3 polyunsaturated fatty acids in some form during the previous 48 hours. The researchers noted that the 19% of participants who had consumed omega-3s via two or more servings of fatty fish has a lower risk for recurrent gout flares (aOR = 0.74; 95% CI, 0.54-0.99), whereas those who used supplements did not demonstrate any risk reduction (aOR = 1.01; 95% CI, 0.631.6).
“The clinical significance of these findings is that there is a promising signal here demonstrating that omega-3 PUFA may have a beneficial role in reducing gout flares if taken at an appropriate dose,” Neogi said. “While fatty fish is not an ideal source for omega-3 PUFA given the concomitant purines in fish, these findings provide proof-of-concept data to support testing omega-3 PUFA supplements at appropriate anti-inflammatory doses in a clinical trial for gout flare prevention.” – by Jason Laday
Disclosure: Neogi reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.
Perspective
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Charles Pritchard, MD
This is an interesting study on the relationship of dietary omega-3 polyunsaturated fatty acid intake (omega-3 PUFA) and subsequent gout flare in patients with a history of gout. The researchers used an internet-based case crossover study from 2003-2012, and found that consumption of fish rich in omega-3 PUFA may lower the risk of recurrent gout flares.
Fatty fish such as tuna, mackerel, and salmon are a natural source of biologically-active omega-3 PUFA. Interestingly, omega-3 PUFA supplement consumption does not appear to reduce the risk, perhaps because of inadequate dosing. The mean total daily intake of fish oil supplements in the community is approximately 0.3 g of omega-3 PUFA, but past rheumatoid arthritis studies have shown an anti-inflammatory effect at 3.4g or higher — a typical serving of a fatty fish can have up to 5.6g of omega-3 PUFA.
Clinically, omega-3 PUFA has shown anti-inflammatory effects in several inflammatory arthritic conditions but few studies have explored the impact of this on gout. In this study, few patients had crystal-proven gout but had a diagnosis of gout confirmed by a physician and a reviewer rheumatologist. The participants completed questionnaires every 3 months over a 12-month period evaluating gout flares, diet, medications, supplements and other parameters.
The results of this study suggest that adequate omega-3 PUFA dosing, either by fatty fish in the diet or with sufficient supplementation, may have a prophylactic effect on gout flares.
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