Beer, ciders increase gout risk in men and women more than other alcohol types
Click Here to Manage Email Alerts
Key takeaways:
- Both men and women demonstrated the greatest increase in gout risk with beer or cider vs. other alcohol types.
- Higher alcohol consumption raised likelihood of gout in both sexes.
Beer and ciders outranked spirits, red wine and other types of alcohol in elevating the risk for gout among men and women, according to a study published in JAMA Network Open.
The study also correlated higher total alcohol consumption with a higher risk of gout, but more strongly in men than women.
“Alcohol intake has been associated with elevated serum urate levels and thus might eventually cause gout through hyperuricemia,” Jie-Qiong Lyu, MPH, of the school of public health at Soochow University, in Suzhou, China, and colleagues wrote. “A number of epidemiologic studies have suggested total or specific alcohol intake to be associated with a higher risk of gout. These studies were limited by using a cross-sectional or case-control design or by including only men.”
To examine link between alcohol consumption and gout in men and women, while avoiding the limitations of previous studies, Lyu and colleagues conducted sex-specific analyses of U.K. Biobank data. In all, the analysis included data from 179,828 men and 221,300 women. As the potential for reverse causation bias remained “an open issue” in previous studies, the researchers stated they attempted to mitigate this by excluding participants who at baseline:
- had reduced alcohol intake for illness or ill health;
- self-rated as having poor health;
- had major cardiovascular disease, cancer or kidney failure; or
- developed gout within the first 2 years of follow-up.
The patients reported their average weekly consumption of alcohol in the following categories: red wine, champagne or white wine, beer or cider, spirits and fortified wine. Their risks for developing gout associated with their alcohol consumption were estimated using multivariable Cox proportional hazards regression models.
According to the researchers, beer or cider carried the greatest gout risk per 1 pint per day for men (HR = 1.6; 95% CI, 1.53-1.67) and women (HR = 1.62; 95% CI, 1.02-2.57). Beer or cider was also the category in which men most outdrank women, consuming an average of 4.2 pints per week vs. 0.4.
The categories least associated with incident gout were red wine among women (HR = 0.92; 95% CI, 0.77-1.1) and spirits among men (HR = 1.12; 95% CI, 1.06-1.19).
Among men, current drinkers demonstrated a higher risk for gout than never-drinkers (HR = 1.69; 95% CI, 1.3-2.18). Meanwhile, women showed no difference between current and never drivers (HR = 0.83; 95% CI, 0.67-1.03). In current drinkers across sexes, higher total alcohol consumption correlated with a higher risk for gout, but to a greater extent in men (HR = 2.05; 95% CI, 1.84-2.3) vs. women (HR = 1.34; 95% CI, 1.12-1.61).
“In this prospective cohort study with a careful consideration of potential confounding and reverse causation, consumption of several specific alcoholic beverages was associated with a higher risk of gout among both sexes,” Lyu and colleagues wrote. “The observed sex-specific difference in the association of total alcohol consumption with incident gout may be owing to differences between men and women in the types of alcohol consumed, rather than biological differences.”
Perspective
Back to Top
David A. McLain, MD, MACR, FACP, FRCP
The association of gout with alcohol has been recognized since antiquity. Hippocrates in the fifth century BCE observed that gout was more prevalent among individuals who consumed large amounts of alcohol and rich foods. We are familiar with the English prints from the 1700s showing the obese gentleman with his great toe bandaged and elevated on an ottoman, holding his glass of port.
The mechanisms responsible for the rise in serum urate caused by alcohol ingestion are not completely understood. The breakdown of ethanol through alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) result in the production of lactic acid, and other organic acids, that compete with uric acid for elimination via organic acid transporter 1 and 3 in the proximal convoluted tubules.
The overall effect is usually pretty modest unless the patient has gene mutations of ADH or ALDH, or the gut purine transporter ABCG2. Also, the presence of generalized obesity and/or fatty liver disease can affect ethanol-associated urate elevation.
Beer is a different story.
Beer is the only form of ethanol ingestion that has any significant impact on serum uric acid (sUA) levels. All forms of beer, including light beers, contain the purine nucleoside called guanosine, which is readily absorbed and broken down to urate. Nicola Dalbeth, MD, FRACP, and colleagues in New Zealand previously estimated that the daily consumption of one beer could raise sUA level by 0.16 mg/dL, while the daily intake of a 6 pack could raise it by approximately 1 mg/dL. Brewer’s yeast and hops, essential ingredients of beer, are also high in purines.
Meanwhile, hard cider — as cited in the current study — wine, and distilled spirits are not a significant source of purines.
Collapse
Read more about
Click Here to Manage Email Alerts