Recent Developments in Diet and Gout

Susan J Lee; Robert A Terkeltaub; Arthur Kavanaugh

Disclosures

Curr Opin Rheumatol. 2006;18(2):193-198. 

In This Article

The Impact of Obesity on Gout

Gout prevalence has approximately doubled over the last two decades, now affecting over 5 000 000 Americans, according to the National Health and Nutrition Examination Survey III (NHANES III). Men are affected more frequently than women, with a prevalence ranging from 6.6 to 44.1 per 1000 in men and 3.9 to 18.2 per 1000 in women.[1,2,9,10,11] Age-adjusted annual incidence for gout also has increased dramatically over the past two decades (from 45 to 62.3 per 100 000).[12] Major factors thought to play a role in the rising prevalence of gout include increases in longevity, use of diuretics and low-dose aspirin, obesity, end-stage renal disease, hypertension and metabolic syndrome.[13,14,15**]

Obesity, defined as a body mass index (BMI) of more than 30 kg/m2, is an enormous public health problem. Data from NHANES have shown a rise in the age-adjusted prevalence of obesity from 22.9% during 1988-1994 to 30.5% during 1999-2000.[16] Current dietary trends, with higher consumption of meat, seafood and fat, in combination with inactivity have contributed to this rising prevalence of obesity. Obesity has been implicated as the second leading preventable cause of death in the United States, with an estimated 280 000 excess annual attributable deaths.[17] Furthermore, obesity is linked to development of insulin resistance (metabolic syndrome), which is complicated by hypertension, hyperlipidemia, coronary artery disease and hyperuricemia. Metabolic syndrome has also been associated with an increased risk of gout.[15**,18,19]

Several epidemiological studies have observed an increased risk of gout in patients with obesity. The Boston Veterans Administration Normative Aging Study[20] prospectively followed 2280 healthy men, aged 21-81 at entry in 1963, and evaluated the incidence of gout and its associated risk factor. Although serum urate level was the most important predictive factor, a proportional hazards regression analysis showed that BMI also was a significant independent predictor for the development of gout. Similarly, data from the Johns Hopkins Precursors Study[21] on 1216 men and 121 women with 40 000 person-years of follow-up noted a strong dose-response effect of BMI on the development of gout. The cumulative prevalence rose from 3.2 per 100 with a BMI of less than 22 kg/m2 to 14.8 per 100 among men with a BMI of more than 25 kg/m2. In addition to the absolute BMI, the relative increase in BMI over time was also associated with an increased risk for gout, with the cumulative prevalence rising to 14.5 per 100 for men who gained more than 1.88 BMI units.

Most recently, the prevalence of gout in relation to BMI was assessed using the data from the Health Professionals Follow-up Study.[3*] This is a large, ongoing longitudinal cohort of 51 529 predominantly Caucasian male health professionals, aged 40-75 at entry in 1986. During the 12-year follow-up, there were 730 newly diagnosed cases of gout. A clear dose-response relationship was noted between BMI and the risk for gout, with the age-adjusted relative risk (RR) increasing from 1.4 to 3.26 for BMIs of 21-23 and 30-35 kg/m2, respectively. Compared with those with stable weight over time, men who gained more than 30 lbs since age 21 had a higher RR of 2.47 for gout after adjusting for age and weight at age 21 years. In contrast, a loss of more than 10 lbs since the study entry was associated with a 30% reduction in the risk of gout (RR 0.61). Similarly, the Nurses Health Study[22] of 92 224 women with no history of baseline gout found a similar dose-response relationship between BMI and the risk of gout, with RRs of 6.13 and 10.59 for BMIs of 30-35 and over 35 kg/m2, respectively. These observations have led to further support of weight loss to prevent recurrent gout attacks. The most effective dietary modification for patients with gout, however, remains controversial, as discussed below.

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