Heart healthy, Mediterranean diets reduce gout risk in women; Western diet increases risk
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High adherence to healthy diet options found within the USDA’s 2020-2025 Dietary Guidelines for Americans, including the heart-healthy DASH or the Mediterranean diet, significantly reduces the risk for gout in women, according to data.
Meanwhile, those who most adhered to the Western diet demonstrated a 49% higher risk for gout.
“Although some have reported on the cross-sectional relationships between dietary intake and either prevalent gout or hyperuricemia — its causal precursor — there is disagreement about the role, and type, of diet in gout prevention,” Natalie McCormick, PhD, of Massachusetts General Hospital and Harvard Medical School, in Boston, told Healio. “We performed a large-scale, prospective study, using validated food frequency questionnaires to assess the relationship between each of four healthy, guideline-based dietary patterns and the development of new-onset female gout.
“It was important to study females since female gout is characterized by a higher cardiometabolic comorbidity burden than male gout, and its global burden is rising disproportionately to male gout,” she added.
To examine the links between dietary scores for eating patterns included in the 2020-2025 Dietary Guidelines for Americans — published by HHS and the USDA — and the risk for gout in women, McCormick and colleagues conducted a prospective cohort analysis of data from the Nurses’ Health Study (NHS). The researchers included information from 80,039 U.S. women from the NHS with no history of gout at baseline. All participants were followed up through questionnaires every 2 years starting in 1984. For this study, McCormick and colleagues used responses submitted through 2018.
The researchers analyzed four healthy eating patterns included in the 2020-2025 Dietary Guidelines for Americans: Dietary Approaches to Stop Hypertension (DASH), Alternate Mediterranean Diet Score, Alternative Healthy Eating Index (AHEI) and Prudent. The Western diet was also included as an unhealthy comparator.
DASH score was based on participants’ reported intake of items emphasized or minimized in the DASH diet, including fruits, vegetables, low-fat dairy and sugar-sweetened beverages. The Mediterranean score returned positive scores for vegetables, fruits, whole grains, nuts, legumes and fish, and negative scores for red and processed meat. The AHEI assigns points to foods and nutrients that have consistently been associated with lower risk of chronic disease in clinical and epidemiologic studies, and the Prudent pattern was characterized by higher intake of fruits, vegetables, whole grains, poultry and low-fat dairy.
The Western diet, meanwhile, was characterized by a higher intake of red and processed meats, refined grains, sweets, desserts and high-fat dairy.
Dietary scores were derived from validated food frequency questionnaires. The primary outcome was a diagnosis of female-specific gout.
According to the researchers, who published their findings in JAMA Internal Medicine, there were 3,890 documented cases of gout among the included participants during 34 years of follow-up. Compared with the least-adherent quintile, those most adherent to healthy diets demonstrated a significantly lower risk for gout, with multivariable-adjusted HRs of 0.68 (95% CI, 0.61-0.76) for DASH, 0.88 (95% CI, 0.8-0.98) for the Mediterranean diet, 0.79 (95% CI, 0.71-0.89) for AHEI and 0.75 (95% CI, 0.73-0.9) for Prudent.
In contrast, women with highest-quintile Western diet scores demonstrated a 49% higher risk for gout (HR = 1.49; 95% CI, 1.33-1.68).
When combined, the most DASH-diet adherent participants with normal BMI had a 68% lower gout risk, compared with those who were least adherence with overweight or obese BMI. When combining high DASH diet adherence with no diuretic use, the corresponding risk reduction was 65%.
“These findings show diet quality is important for reducing gout risk, in addition to adiposity,” McCormick said. “Instead of the low-purine — low-protein — diets traditionally encouraged for those with hyperuricemia or gout, which can worsen cardiometabolic health, a woman looking to reduce her risk of gout can choose from several healthier and more enticing dietary patterns, including the DASH and Mediterranean, according to her personal preferences and circumstances.
“These findings extend the cardiovascular benefits of the 2020-2025 Dietary Guidelines for Americans to female gout prevention,” she added. “Women at risk for developing gout should be encouraged to follow one of these established dietary patterns, which have been inversely associated with biomarkers of insulin resistance and inflammation, along with other lifestyle modifications. The choice of diet can be guided by personal preferences, food traditions and comorbidity profile — eg, consider DASH for those with hypertension.”
Perspective
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David A. McLain, MD, MACR, FACP, FRCP
The expression “you are what you eat” is credited to Victor Lindlahr, DO, a radio host and health food writer, who published a book by that name in 1940. The concept has also been attributed to the French lawyer Anthelme Brillat-Savarin, who wrote in Physiologie du Gout, ou Meditations de Gastronomie Transcendante, “Tell me what you eat, and I will tell you what you are.” “Gout” in this title refers to “taste.”
The idea that what you eat can influence your health was also popularized by Adelle Davis, the most famous nutritionist/author of the mid-20th century. Davis preached the benefits of whole grains, fresh vegetables, vitamin supplements, limits on sugar and avoidance of packaged and processed foods. She felt that many diseases had poor nutrition and processed food in their pathogenesis.
Using the Nurses’ Health Study, the authors of the present study were able to separate respondents into different diets (DASH, Mediterranean, AEHI 2010, Prudent and Western). The “better” diets were associated with a significantly lower risk for gout. In general, these diets included fruits, vegetables, nuts, legumes, fish, poultry and whole grains. In contrast, the Western diet had a higher intake of red and processed meats, refined grains, sweets, desserts and high-fat dairy, and was associated with a higher risk for developing gout. We see from this present publication that diet has a direct impact on the development of gout in women.
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