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 Diet Including Dairy Products on Gout

Heavy consumption of purine-rich foods ('feasting'), particularly with concurrent alcohol intake, has long been associated with the development of flares of acute gout. The relationship between the consumption of purine-rich foods and the risk of developing gout was recently evaluated in a large prospective cohort[31] of more than 47 000 male health professionals aged 40 and older without gout at baseline (the Health Professionals Follow-Up Study). During the 12-year follow-up,[32] 730 new cases of gout were identified, with the peak at between 55 and 69 years of age. Validated semi-quantitative food-frequency questionnaires were used to obtain dietary information every 2 years. Men with the highest quintiles of meat and seafood intake were noted to have an increased risk of gout compared with those in the lowest quintile, with ORs of 1.41 (95% CI 1.07-1.86) and 1.51 (95% CI 1.17-1.95), respectively. For those with highest seafood intake, this observed risk was heightened among those who were less overweight (BMI of less than 25 kg/m2). This seemingly paradoxical observation may be related to a difference in purine metabolism, though this remains purely speculative at this time.

Neither total protein intake nor consumption of purine-rich vegetables was associated with an increased risk of gout. Indeed, men with the highest quintile of vegetable protein had lower risk of gout compared with those with the lowest quintile (OR 0.73). Similarly, dairy intake was inversely correlated with the risk of gout, with OR of 0.56. This protective effect was only evident with low-fat dairy products, such as skim milk and low-fat yogurt. It remains possible that small changes in uricosuria induced directly by dairy products over periods of many years can reduce the risk of developing gout. Subjects with high use of low-fat dairy products, however, may represent a distinct population subgroup, as those consuming low-fat dairy may be more attuned to health issues in general. Observed associations with incident gout in the Health Professionals Follow-Up Study appeared to be independent of other individual risk factors, such as age, underlying medical conditions (e.g. hypertension, renal failure), alcohol use, the use of diuretics and BMI, with the noted exception of seafood intake.[5*,33] Ascertainment bias, however, may well have entered into calculations of both serum uric acid level in NHANES III and the risk of developing gout in heavy consumers of dairy products in the Health Professionals Follow-Up Study.[4*,5*]

In the Health Professionals Follow-Up Study, the authors evaluated the robustness of the results by using various definitions of gout. These associations tended to become more prominent as more specific definitions of gout were used. As the study was restricted to middle-aged men, the results cannot be generalized to the overall population without further study. A prospective work on females from the Nurses Health Study[34] of 92 224 women, however, noted a similar protective effect of dairy product consumption - especially low-fat dairy product - on the incidence of gout (OR 0.82). Both of these studies would have been further strengthened if the direct impact and interaction of insulin resistance and metabolic syndrome on the risk of gout were assessed. Nonetheless, these were the first two large prospective studies of their kind and they have added significantly to our current understanding of the impact of diet on the incidence of gout.

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