Background/Purpose: There is a remarkable, rising disease burden of gout and associated
cardiovascular-metabolic comorbidities (e.g., hypertension in 74% and
obesity in 53% of cases in the US),
underscoring an urgent need for holistic strategies to effectively address
these conditions together. Individual dietary risk factors have been identified;
however, a piecemeal approach focusing on certain specific dietary risk factors
is often ineffective or impractical, and does not address comorbidities of gout.  In contrast, a dietary pattern approach (e.g.,
the DASH or Western diet) reflects the way foods are consumed in reality, and can
address the net health benefit and enhance applicability and sustainability in practice;
however, data on dietary patterns and the risk of gout are scarce. We
prospectively examined the relation between 3 major dietary patterns (the DASH,
Prudent, and Western Diets) and the risk of gout in a large prospective study
of US women.

Methods: We
studied the risk of incident gout in 78,906 female participants using the
American College of Rheumatology survey criteria for gout.  Using
dietary information obtained every 4 years over 22 years (1984-2006), we
created a DASH dietary score based on its components, which emphasize fruits,
vegetables, low-fat dairy foods, and reduced intake of saturated and total fat
and sugar-sweetened beverages.  We
also identified two major dietary patterns (using factor analysis): “prudent”
(characterized by higher consumption of vegetables, fruit, fish, poultry, and
whole grains) and “western” (characterized by higher consumption of red meat,
processed meat, fries, high-fat dairy products, refined grains, sweets, and
desserts).  We then calculated these pattern
scores for each participant and prospectively examined the association between
dietary pattern scores and the risk of gout, adjusting for potential
confounders.

Results: During 22 years of follow-up, we documented
778 confirmed cases of incident gout.  The
DASH dietary pattern score was associated with a lower risk for gout (relative
risk [RR] for extreme quintiles, 0.67 [CI, 0.53 to 0.84]; P <0.001 for
trend).  Similarly, the prudent dietary
pattern score was associated with a modestly lower risk for gout (RR for
extreme quintiles, 0.76 [CI, 0.60 to 0.97]; P = 0.04 for trend).  In contrast, the western dietary pattern score
was associated with an increased risk for gout (RR, 1.68 [CI, 1.28 to 2.21]; P
<0.001 for trend).

Conclusion: The Western dietary pattern is associated
with an increased risk of gout, which explains the rising burden of gout in Western countries.  In contrast, the DASH diet and prudent dietary pattern are associated with a lower
risk of gout.  The DASH diet appears to offer an attractive additional nutritional
approach for gout, as it also reduces blood pressure in hypertension (present in 74% of gout patients) and
is also recommended to prevent CVD (a common comorbidity of gout).