Here Are ‘Girl Dinners’ to Avoid to Limit Gout Risk

Some dietary habits are worse than others when it comes to gout risk for women, a large study indicated.

Data from the two iterations of the Nurses’ Health Study, in which more than 170,000 women were followed for more than two decades, indicated that diets scoring high on the Empirical Dietary Inflammatory Pattern (EDIP) index nearly doubled the risk for new-onset gout after adjusting for body mass index (BMI), according to Natalie McCormick, PhD, of Massachusetts General Hospital in Boston, and colleagues.

Compared with the lowest quintile of EDIP scores, those in the highest quintile had a BMI-adjusted hazard ratio of 1.71 (95% CI 1.55-1.88) for incident gout, the group reported in Arthritis & Rheumatology.

McCormick and colleagues also found that, when they inverted the analysis to estimate the protective effect of diets with low EDIP scores, it was significantly greater than for top-rated diets according to two more common healthy-diet scoring systems.

And EDIP scores were markedly more relevant for women than for men: when the researchers examined data for some 45,000 men in the 30-year Health Professionals Follow-up Study, the highest EDIP quintile had only a 24% greater risk for developing gout than the lowest quintile, after BMI adjustment.

“Our findings support a role for diet-related chronic inflammation in the development of gout, similar to that seen in [cardiovascular disease and type 2 diabetes],” McCormick and colleagues wrote. “Consuming a more anti-inflammatory diet may modulate systemic and metabolic inflammation, potentially reducing gout risk and its life-threatening comorbidities, particularly for women, who are experiencing a disproportionate rise in gout burden.”

One of the group’s motivations in doing the study was the observation that gout — historically considered a men’s disease — is becoming more prevalent in women. One recent global study found age-standardized rates rising 0.38% annually for women during 1990-2017 versus 0.22% among men. Changing lifestyle behaviors are believed to be the major reason.

“Adherence to established healthy eating patterns such as the Dietary Approaches to Stop Hypertension (DASH) and the Alternative Healthy Eating Index (AHEI), each associated with lower plasma concentrations of inflammatory biomarkers, is also inversely associated with gout incidence,” McCormick and colleagues observed. “However, neither of these dietary patterns were derived specifically to predict inflammation, and research on a pro-inflammatory dietary pattern and gout remains limited.”

So the group pulled data from the original Nurses’ Health Study, which ran from 1984 to 2016, and its Nurses’ Health Study II follow-on that began in 1991 and ended in 2017. In total, these studies yielded 4,372,320 person-years of data, during which 5,425 women developed new-onset gout. These studies included detailed food-frequency questionnaires, repeated every 4 years, that allowed the researchers to score participants’ diets by EDIP, DASH, and AHEI.

Without adjusting for BMI, participants in the highest EDIP quintile developed gout at a rate 2.02 times than of the lowest quintile (95% CI 1.82-2.22). Results were similar in a sensitivity analysis when participants with pre-existing cardiovascular disease, type 2 diabetes, and malignancies were excluded.

A feature of the EDIP system is that it divides its 18 food groups into pro- and anti-inflammatory components. The former include most meat and fish varieties, refined grains, soft drinks, and tomatoes; the latter comprise beer, wine, fruit juices, dark yellow and leafy green vegetables, “snacks,” and — yes — pizza.

McCormick and colleagues recalculated EDIP scores according to their anti-inflammatory strength, and determined that the highest quintile had a hazard ratio of 0.58 (95% CI 0.53-0.65) for incident gout relative to the lowest quintile.

Corresponding hazard ratios for the top quintiles of DASH and AHEI score versus the lowest were 0.80 (95% CI 0.73-0.87) and 0.81 (95% CI 0.74-0.89), respectively.

The researchers had no definitive explanation for the finding that EDIP scores were less predictive of gout risk for men than for women, but they speculated that estrogen may play a role. “Higher estrogen levels in women may have anti-inflammatory properties under certain conditions,” they wrote, “although this effect may be lost after menopause, thereby potentially contributing to gout risk. Future prospective studies ought to replicate this observed heterogeneity.”

Limitations to the study included a lack of serum urate measurements and the potential for residual confounding; people’s recall of their dietary habits is also notoriously subject to bias. As well, study participants were well-educated and mostly white, limiting the generalizability to the female population at large.

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