Western diet increases gout risk, Harvard team warns

By Will Chu

- Last updated on GMT

Gout is a joint disease which causes extreme pain and swelling. It is most common in men aged 40 and older and is caused by excess uric acid in the blood (known as hyperuricaemia) which leads to uric acid crystals collecting around the joints.©iStock/Massonstock
Gout is a joint disease which causes extreme pain and swelling. It is most common in men aged 40 and older and is caused by excess uric acid in the blood (known as hyperuricaemia) which leads to uric acid crystals collecting around the joints.©iStock/Massonstock
A diet plentiful in nuts, whole grains, fruits and vegetables, and low in salty, red, processed meats and sugary soft drinks may lower the incidence of gout, a BMJ study has concluded.

The diet, characteristic of those found in the Mediterranean, may provide an attractive preventive dietary approach for individuals at risk of gout.

Current estimates​ place the prevalence of gout in this region as low as 0.91% of the population in Italy and only 0.9% of 10,026 adult participants in metropolitan France​.

In contrast, estimates of gout prevalence in the UK was 3.22% in adults (aged over 20 years) and 2.49% in the entire population, ​which are similar to estimates reported in Spain and the Netherlands.

“We found that the Western diet was independently associated with an increased risk of gout,”​ the study authors declared.

“This provides the first prospective evidence that the Western diet, reflecting fast foods abundantly available in Western countries, can explain the increasing prevalence of gout observed in such settings.”

DASH adoption

mediterranean food
The DASH diet shares similarities with the Mediterranean diet in their emphasis on fruits, vegetables and wholegrains. ©iStock

The 26-year study adopted the Dietary Approaches to Stop Hypertension (DASH) diet – a regimen that emphasises the intake of fruits, vegetables, low fat dairy foods, and reduced saturated and total fat.

The team looked to lower serum uric acid levels that are heightened among people following a typical Western diet.

Teams from Harvard University and Arthritis Research Canada, began pouring over data that looked into completed food questionnaires submitted by 44,000 men aged 40 to 75 years with no history of gout.

These questionnaires were completed in 1986 and updated every four years through to 2012.

Each male was given a DASH score (reflecting high intake of fruits, vegetables, nuts and legumes, low-fat dairy products and whole grains, and low intake of salt, sweetened beverages, and red and processed meats)

They were also assigned a Western pattern score reflecting higher intake of red and processed meats, French fries, refined grains, sweets and desserts.

During the follow-up period, 1731 confirmed cases of gout were documented.

Here it emerged a higher DASH score corresponded to a lower risk for gout. Meanwhile, a higher Western pattern was associated with an increased risk for gout.

These associations were independent of known risk factors for gout, such as age, body mass index, high blood pressure, and alcohol and coffee intake.

“Components of the DASH diet substantially overlap with previous study findings of individual dietary risk factors for hyperuricemia and gout such as meat, seafood, alcohol, fructose-rich beverages, as well as protective (or neutral) factors such as low fat dairy intake, vegetables, cherries, legumes, nuts, and plant protein,”​ the study remarked.

"This explains why the dietary pattern is associated with a lower risk of gout. Reduced purine loading and insulin resistance, as well as the resulting uricosuric effects (increased uric acid excretion in the urine) are potential mechanisms behind anti-gout foods leading to lower serum uric acid levels."

Diet palatability

The findings also have a practical element in gout prevention, according to the researchers, providing a viable approach to current disjointed attempts to modify specific dietary risk factors.

Focusing exclusively on reducing protein content in the conventional diet low in purine, for example, often provides an incomplete dietary recommendation without considering the proper replacement with healthy calorie sources.

This in turn could actually worsen the metabolic syndrome and its consequences which include hyperuricemia and gout.

“In contrast, a healthful complete dietary pattern approach such as the DASH diet reflects the way foods are consumed in reality and can facilitate the dissemination and adoption (by providing comprehensive diet instructions and ongoing support) in both public health and clinical practice,”​ the study concluded.

The team also highlighted the DASH diet’s palatability as another important advantage, adding to its long-term adherence and success.

A post hoc survey​ of a DASH trial found that participants enjoyed the DASH diet and were willing to continue with it more than the control diet.

©iStock/

Source: BMJ

Published online ahead of print: DOI: 10.1136/bmj.j2238

“The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study.”

Authors: Sharan Rai, Teresa Fung, Na Lu, Sarah Keller, Gary Curhan, Hyon Choi

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