Background/Purpose: Gout is characterised by intermittent flares of inflammation in response to monosodium urate crystals in the joints. Gout flares can be triggered by dietary factors that raise serum urate. Tomato consumption is an anecdotal trigger of gout flares. This study aimed to measure the frequency of tomato consumption as a self-reported trigger of gout flares in a New Zealand gout sample set, and to use publically available data to test the hypothesis that tomato consumption is associated with levels of serum urate. 

Methods: 1324 New Zealand people (of Māori, Pacific Island, European or other ancestry) with clinically ascertained gout were asked about dietary triggers of gout. European individuals from the Atherosclerosis Risk In Communities (ARIC, n=7517), Cardiovascular Health Study (CHS, n=2151) and Framingham Heart Study (FHS, n=3052) were used to test for association between serum urate and self-reported tomato intake using two models. Model 1 was adjusted for age, BMI, average calorie intake (kcal/day), principal components analysis vectors 1 and 2 from genome-wide genotype data and model 2 additionally adjusted for meat, seafood/fish, sugar sweetened soft drinks/juices, dairy products, coffee, vitamin C and alcohol consumption.

Results: At least one dietary trigger was reported by 970/1324 (73.3%) of the New Zealand participants with gout. Tomatoes as a dietary trigger was mentioned by 178/970 (18%) participants, making this the 4^th most commonly reported dietary trigger in New Zealand men and women. Seafood or fish (634/970; 65%), alcohol (501/970; 52%) and red meat (374/970; 39%) were more frequently reported than tomatoes.  In the analysis of the ARIC, CHS and FHS datasets, there was association between tomato intake and serum urate levels (β=0.66 μmolL^-1 per weekly serving; P=0.006), which was evident in both men and women (Table; Model 1). This association was also maintained after adjustment for consumption of all other urate associated dietary exposures (all: β=0.66 μmolL^-1, P=0.008) (Table; Model 2).

Conclusion: Tomatoes are a common self-reported trigger of gout flares. Whilst our descriptive and observational data are unable to support the claim that tomato consumption is a trigger of gout attacks, the positive association between tomato consumption and serum urate levels suggests that the self-reporting of tomatoes as a dietary trigger by people with gout has a biological basis.

Table 1: Association Between Serum Urate Levels (μmolL^-1) And Tomato Consumption (serves/week) in the European meta-analysis combined cohort

		Model 1				Model 2
		β [95% CI]	P	Het P		β [95% CI]	P	Het P
Men		0.84 [0.06; 1.62]	0.035	0.15		0.67 [-0.12; 1.45]	0.099	0.11
Women1		0.59 [0.02; 1.16]	0.041	0.51		0.63 [0.05; 1.22]	0.035	0.78
All2		0.664 [0.19; 1.13]	0.006	0.54		0.66 [0.17; 1.14]	0.008	0.33

 

 

 

 

 

 

¹Adjusted for menopause status.

²Adjusted for sex and menopause status.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/positive-association-between-tomato-consumption-and-serum-urate-investigating-an-anecdotal-trigger-of-gout-flares/