Background/Purpose: The Health Professional Follow up Study in Caucasian men showed that intakes of meat and seafood increased risk of gout, while dairy products, especially low-fat dairy products, reduced the risk (1). Purine rich vegetable intake had no association with incident gout (1). Studies evaluating diet on gout risk in Asian populations are lacking. Most of these studies focused on alcohol intake and evaluated on hyperuricemia rather than gout as the dependent variable. We examined the relation of dietary protein and protein sources with incident gout among Chinese men and women.

Methods: We used data from the Singapore Chinese Health Study, a prospective cohort study with 63,257 Chinese adults aged 45-74 years at recruitment from 1993 to 1998. Dietary information was collected via a validated food frequency question, and physician-diagnosed gout was self-reported during the two follow-up visits of 1999-2004 and 2006-2010. We conducted analysis among 51,114 participants without gout at baseline and who responded to the follow-up questionnaires. Cox proportional hazards models were used to calculate the relative risk (RR) and 95% confidence interval (CI) with adjustment for potential confounding factors, including age, sex, alcohol intake, body mass index and hypertension. All multivariate models were further adjusted for protein sources.

Results: Among 51,114 subjects interviewed at either or both interviews, after a mean follow-up of 11.1 (SD 3.7) years, there were 2,167 incident gout cases with mean age of onset at 61.3 (SD 8.1) years. Participants with gout were more likely to be men, more highly educated, ever smokers, weekly or daily alcohol drinkers and to have higher BMI then those without gout. 36.8% of gout subjects had hypertension compared with 21.4% among those without gout. Compared to the lowest quartile intake, the multivariate-adjusted RRs (95% CI) of incident gout in the highest quartile were 1.27 (1.12-1.44) for total protein (P_trend=0.001); 1.28 (1.12-1.47) for poultry (P_trend=0.001); and 1.16 (1.02-1.32) for fish and shellfish (P_trend=0.014). Conversely, intakes of soy and other legumes were associated with reduced risk, the RR (95% CI) in the highest quartile intake being 0.87 (0.77-1.00) for soy foods (P_trend=0.01) and 0.85 (0.74-0.97) for legumes (P_trend=0.02). There was no association between intake of red meat (including pork), eggs, dairy products, grain products, nuts and seeds, and risk of gout. There was no significant interaction between sex, BMI, history of hypertension, smoking and alcohol consumption status, and intake of foods on risk of gout.

Conclusion: Total protein intake, mainly contributed by poultry, fish and shellfish, was associated with increased risk of gout in this population. Conversely, soy and legume foods may be related to reduced risk of gout. The general advice of replacing red meat with “white meat” such as poultry may not be advisable. Myths of deleterious effect of soy and legume intake on gout may be debunked. Other health benefits of soy plus a possible protective effect on gout makes it a plausible vegetable-based meat substitute.

1. Choi HK et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. NEJM. 2004;350(11):1093.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/food-sources-of-protein-and-risk-of-incident-gout-in-the-singapore-chinese-health-study/