Genetics play role in how DASH diet impacts gout risk among women
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Although the DASH diet can lower gout risk in women regardless of genetics, nonadherence can result in a greater risk in those with a higher predisposition for elevated serum urate, according to a speaker at the EULAR 2021 Congress.
Chio Yokose, MD, of Massachusetts General Hospital, in Boston, who presented the data on the 34-year study, added that, in contrast to the heart-healthy Dietary Approaches to Stop Hypertension, or DASH, diet, adherence to the Western diet was associated with a higher risk for incidence gout in women. However, there was no evidence of an additive or multiplicative association between the Western diet and genetic predisposition on the risk for gout, she said.
“Gout has traditionally been considered a disease that primarily affects men,” Yokose told attendees during the virtual meeting. “Two recent analyses of the Global Burden of Disease Study reported on the rising trajectory of gout burden worldwide between 1990 and 2017. These analyses reported on a disproportionate worsening of gout burden among women, a group that is often overlooked in gout studies.”
“In our previous work, we have shown that the Dietary Approaches to Stop Hypertension — or DASH — diet is independently associated with lower risk of incident gout, while the Western diet is associated with an increased risk,” she added. “In addition to diet and other lifestyle risk factors, it is also recognized that there is a significant genetic contribution to hyperuricemia and gout. However, it is not yet known whether genetic predisposition may modify the effect of diet on the risk of gout.”
To examine the impact of genetic factors on the relationship between diet and the risk for gout in women over a period of 34 years, Yokose and colleagues conducted a prospective cohort study of data on 18,247 women from the Nurses’ Health Study.
Focusing on data from the years 1984 to 2018, the researchers used validated food frequency questionnaires to score adherence to either the DASH diet — defined as emphasizing fruits, vegetables, nuts, legumes, whole grains, low-fat dairy and a reduced intake of saturated fat and sugar-sweetened beverages — or the Western diet — characterized by a high intake of red and processed meats, sugar-sweetened beverages, desserts, french fries and refined grains. Adherence was scored on a scale of Q1 to Q5, with Q1 being the least adherent and Q5 being the most adherent.
The researchers also calculated genetic risk scores using 114 serum urate single nucleotide polymorphisms from a European ancestry meta-analysis, with higher scores indicating a greater genetic predisposition for elevated serum urate. The primary outcome was self-reported incidence gout diagnosis, from a physician, on biennial health questionnaires. Medical record reviews were used to confirm participants’ self-reported diagnoses, with 91% fulfilling the criteria for gout.
The statistical analysis included a Cox proportional hazards model, to examine the link between quintiles of diet adherence scores and the risk for gout, according to whether participants’ genetic risk score was above or below the mean, all while adjusting for previously identified risk factors for gout. Those with a below-mean genetic risk score who had a Q5 DASH adherence, and those with a Q1 Western diet adherence, were used as reference groups for their respective diets. Both additive and multiplicative interactions between genetic risk score and diet were assessed.
According to Yokose, there were 481 cases of incident gout among participants without a genetic predisposition, and 859 cases among those with a genetic risk score above the mean. For the DASH diet, those with a below-mean genetic risk demonstrated relative risk scores of 1.43, 1.48, 1.36, 1.31 and 1 for the Q1, Q2, Q3, Q4 and Q5 adherence levels, respectively. Meanwhile, for those with an above-mean genetic risk, the relative risk scores were 2.79, 3.11, 2.53, 1.72 and 1.76, respectively, representing an additive interaction of 0.57 (P = .06) and a multiplicative interaction of 1.12 (P = .56).
For the Western diet, those with a below-mean genetic risk demonstrated relative risk scores of 1, 1.18, 0.98, 1.2 and 1.58 for the Q1, Q2, Q3, Q4 and Q5 adherence levels, respectively. For those with an above-mean genetic risk, the relative risk scores were 1.93, 1.94, 2.01, 2.22 and 2.74, respectively, representing an additive interaction of 0.2 (P = .52) and a multiplicative interaction of 0.9 (P = .57).
“Among women, increasing adherence to the DASH diet was associated with a reduced risk of incident gout, and the opposite was true of the Western diet,” Yokose said. “The additive interaction on the absolute risk scale between DASH diet score and genetic predisposition approached statistical significance. However, there was no evidence of additive or multiplicative interaction for the Western diet.”
“Diet and genetic predisposition are significantly associated with the risk of incident gout,” she added. “These results suggest that public health interventions to increase adherence to the DASH diet would have a bigger impact among genetically susceptible individuals. Therefore, targeted dietary interventions may have a significant impact on mitigating the growing global burden of gout.”
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Yokose C. Gene-diet interaction on the risk of incidence gout among women — prospective cohort study over 32 years. Presented at EULAR 2021 Congress; June 2-6, 2021 (virtual meeting).
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