Addressing obesity may prevent most incident gout cases in men
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Avoiding obesity, alcohol consumption and diuretic use, while maintaining a DASH-style diet, may prevent most incident gout cases among men, according to data published in JAMA Network Open.
“Paralleling the modern obesity epidemic (a trait of the metabolic syndrome), the disease burden of gout has been increasing worldwide, even reaching the level of a ‘modern gout epidemic’ in Western countries, with hospitalization rates and costs due to gout doubling alongside, in the U.S. and beyond,” Natalie McCormick, PhD, of Massachusetts General Hospital and Harvard Medical School, and colleagues wrote. “These data collectively underscore the need for primary prevention of this painful condition, which can be achieved by modifying its risk factors at the population level.”
“A recent cross-sectional study reported a minimal variance of serum urate (SU) levels (causal precursor for gout) in the U.S. explained by an isocaloric dietary pattern, whereas a subsequent cross-sectional analysis found a substantial proportion of hyperuricemia cases could potentially be prevented by modifying individual risk factors such as obesity, healthy dietary pattern, alcohol intake and diuretic use,” they added. “However, to date, the proportion of actual gout itself that could potentially be prevented by modifying such factors remains unknown.”
To assess the proportion of incident gout cases that could be prevented by addressing obesity and other factors simultaneously, McCormick and colleagues analyzed data from the Health Professionals Follow-up Study (HPFS). According to the researchers, the HPFS is an ongoing prospective cohort study of 51,529 male dentists, optometrists, osteopaths, pharmacists, podiatrists and veterinarians enrolled in 1986. Every 2 years, the participants return a mailed questionnaire assessing their medical history, current diet and lifestyle habits. The follow-up rate exceeds 90%.
For their own analysis, McCormick and colleagues excluded men with a diagnosis of gout at baseline and used questionnaires through 2012. Self-reported gout cases were confirmed through June 2015, and “clean and complete” data were available in June 2016, with statistical analysis performed from July 2016 to July 2019, the researchers wrote. In all, 44,654 men were included in the analysis. The researchers categorized each participant into low-risk groups based on four factors — normal BMI, no alcohol consumption, no diuretic use, and adherence to the DASH-style diet. Normal BMI was defined as less than 25.
The main outcome was the population attributable risk (PAR) for incident gout meeting the preliminary American College of Rheumatology survey criteria, both overall and stratified by BMI.
According to the researchers, 3.9% of the included participants developed incident gout during the 26 years of follow-up. Among all included participants, the PAR for the four risk factors combined was 77% (95% CI, 56% to 88%). Among men with normal BMI, and who were overweight, with a BMI of 25 to 29.9, as much as 69% (95% CI, 42% to 83%) and 59% (95% CI, 30% to 75%) of gout cases, respectively, may have been prevented by a combination of DASH-style diet, no alcohol consumption and no diuretic use.
However, among men with obesity — a BMI of 30 or higher — PAR was substantially lower and not significant, at 5% (95% CI, 0% to 47%).
“Our findings from this cohort of men suggest the majority of gout cases could potentially be prevented by achieving and maintaining a normal weight, avoiding alcohol consumption, eating a DASH-style diet, and avoiding diuretic use,” McCormick and colleagues wrote. “Men with obesity may not benefit from other modifications unless weight loss is addressed.”
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