— Four addressable factors appear key

by Kristen Monaco, Staff Writer, MedPage Today November 24, 2020

Reducing four particular risk factors for gout could slash incident cases in men, researchers reported.

Over a 26-year period, about 77% (95% CI 56%-88%) of men likely could have avoided gout if they likewise avoid four major risk factors — high BMI, poor diet high in salt, alcohol intake, and use of diuretics, according to Hyon Choi, MD, DrPH, of Massachusetts General Hospital in Boston, and colleagues in JAMA Network Open.

Choi’s group projected that about 69% (95% CI 42%-83%) of men of normal weight may have been able to totally avoid developing gout by adhering to a DASH-style diet, high in fruits, vegetables, and low-fat dairy, as well as low in red or processed meats and sweetened beverages, and consuming no alcohol. Also, not using diuretics.

Similarly, they projected that 59% (95% CI 30%-75%) of incident gout cases among overweight men could have been deterred by avoiding an unhealthy diet, alcohol consumption, and diuretic use.

However, obesity was such a strong predisposing risk factor for gout that only a few men with obesity could’ve avoided gout by attenuating for the other three risk factors. Even if these men stuck to a DASH diet and avoided alcohol and diuretics, only about 5% of incidence gout cases may have been thwarted (not reaching statistical significance).

“Men with obesity may not benefit from other modifications unless weight loss is addressed,” the authors stated.

The researchers drew upon data from nearly 45,000 U.S. adult men from the Health Professionals Follow-up Study. This cohort included mainly white men over age 40 who were free of gout at baseline. During the over 2 decades follow-up, about 4% of men developed incident gout.

Even in the absence of avoiding any of the other risk factors for gout, simply adhering to the DASH diet likely could’ve avoided 22% of incident gout cases, thus “supporting a considerable role of this isocaloric dietary pattern in reducing incident gout risk,” Choi and colleagues wrote. “Moreover, adoption of the DASH diet could further prevent and treat related conditions including hypertension, which affects nearly 75% of patients with gout.”

Overall, BMI was the strongest risk factor, as those with a BMI of 30 or higher had more than a two-fold higher for incident gout (relative risk 2.65, 95% CI 2.18-3.22) versus men with a BMI under 23.

Choi’s group explained a “potential causal relationship between obesity, serum urate level, and the risk of gout is supported by its mechanistic plausibility, prospective cohort studies, Mendelian randomization studies, and weight loss interventions through bariatric surgery or lifestyle modification.”

They pointed out that as global obesity levels continue to trend up, so does the “rising gout burden.”

The research builds on a previous study that found obesity, hypertension, and use of diuretic medications were independent risk factors tied to incident gout, with each factor doubling the risk for the condition.

Limitations to the current observational study included possible residual and unmeasured confounding, as well as the fact that data from white male healthcare professionals may not apply to women or the general population.