Is it time to stop blaming booze and bad food for the ‘disease of kings’?
Two recent studies have found that diet likely plays less of a role in gout than once thought, but a healthy weight may be associated with a lower risk of developing the disease.
The first study, an observational study of over 400,000 people published in Arthritis Research & Therapy, has found that diet did not play a significant role in hyperuricaemia, the high levels of uric acid in the blood linked to gout.
The researchers collected data from four cohorts with European ancestry from the Database of Genotypes and Phenotypes and the UK Biobank resource. Three of these cohorts consisted of members of the general population in the US and UK, and people in the UK with gout comprised the fourth.
They then sorted participants according to diet, genetic risk variants, BMI, alcohol use, diuretic treatment, sex and age to calculate which risk factor contributed the most. In the gout cohort, the contribution of urate-lowering therapy was also assessed.
The team discovered that diet had a minor role in determining uric acid levels and hyperuricaemia. In contrast, the use of urate-lowering therapy had the most prominent effect on hyperuricaemia.
“[The study] reaffirms the importance of taking medication to prevent the formation or dissolve crystals in the joints, and hopefully prevent joint damage,” said Dr Ken Cai, a rheumatologist at Westmead Hospital in New South Wales.
“People think that gout is the disease of excess or it’s related to people who don’t look after themselves, drink too much or eat too much bad food,” said Dr Cai, adding that the role of diet has been very much overblown.
However, he pointed out, while drastically changing diet does not necessarily have a significant impact on gout disease, there are substantial benefits to losing weight and eating healthier – not only for gout, but also in lowering cardiovascular disease risk, preventing diabetes and improving overall health.
To this point, a second study, also published in Arthritis Research & Therapy, has found that gaining weight over adulthood was associated with increased gout risk. Conversely, reaching and maintaining a healthy weight during adulthood might prevent and help gout treatment.
Using data from the National Health and Nutrition Examination Survey (NHANES), the research team conducted a retrospective analysis of over 10,000 adults aged 40–74 years in the US, 320 of whom developed gout.
They categorised individuals into four weight change patterns: those whose BMI started and remained in the obese range, those who gained weight and became obese, those who were obese and lost weight and those who remained non-obese.
Researchers found that people who started and remained obese had the highest risk of developing gout, and gaining weight was also associated with an increased risk for gout. Those who maintained a non-obese weight had the lowest risk. Losing weight was associated with reduced risk of gout, although the numbers were too small to show significance.
“Clearly, there is a benefit of addressing weight when a patient is obese,” said Dr Cai, but pointed out the study only suggested an association between obesity and gout rather than causation.
“There can be a lot of factors involved over time. As people get older, they might acquire more medical problems, and there might be other factors at play, which can be difficult to fully account for,” he said.
“For those who are overweight or obese, it’s important to address that because it is part of improving their risk factor profile for many conditions.”
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