Background/Purpose: Gout is the leading cause of inflammatory arthritis in men and is linked to higher levels of body weight and obesity in mid-adult life. However, few, if any, observational cohorts have examined the association of body weight across the life span with incident gout. We sought to determine whether weight, assessed in young, mid and late-adult life, predicted the subsequent development of gout.

Methods: Body mass index [BMI] was first calculated at a mean age of 23 (+2) years among 1040 male former medical students who graduated from 1948-1964. Thereafter, BMI was re-assessed in each decade of adult life. Incident gout was ascertained during follow-up using self-administered questionnaires and confirmed in a subset of participants according to American College of Rheumatology criteria. Survival analysis techniques were used to examine the association of BMI in each age interval with incidence of gout, with adjustment for comorbid hypertension at time of BMI, cholesterol level and alcohol consumption at cohort entry.

Results: In this prospective cohort study, the mean weight at cohort entry was 75.6 (+9.8) kilograms, height was 1.81 (+0.06) meters, corresponding to mean BMI of 23.1 (+2.6) kg/m². During a median follow-up of 45 years, a total of 158 men developed gout. Notably, the youngest age at which gout first occurred was 28 years. Thereafter, 6 men developed gout by age 35 years, an additional 36 developed gout by age 50 years, 36 more between ages 50-65 years, and finally, 70 men developed gout between 65 to 88 years of age. The cumulative incidence of gout by age 45 years was 2.2%, by 55 years was 5.4%, by 65 years was 8.5%, by age 75 years was 14.4%, and the cumulative incidence of gout by 85 years was 21.0%. Further, at each period in the adult life spectrum, a dose-response association was observed between successively higher tertiles of BMI with gout incidence (Table; each logrank p<0.06). Moreover, those men in the highest tertile of BMI (at ages 35, 50 and 65) experienced a heightened risk to develop gout over the next 15-20 year period (between ages 35-50, 50-65, and 65-85, respectively,) compared to those in the lowest BMI tertile, an association largely explained in the late adult period by comorbid hypertension.

Conclusion: The incidence of gout in men rises during each decade of the lifespan. Body weight in young, mid and late adult life, each predicted gout incidence during the subsequent age period. These findings imply that across the lifespan, overweight and obesity are potential modifiable targets in the primary prevention of gout.