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Abstract Number: 1131

The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean Diets and Risk of Gout in Women: 28-Year Follow-up of a Prospective Cohort

Sarah Keller1, Sharan K. Rai2, Leo Lu3, Yuqing Zhang4 and Hyon K. Choi2, 1Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 2Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 3Allergy, Immunology, and Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 4Department of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Gout and nutrition

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Session Information

Date: Monday, November 6, 2017

Title: Metabolic and Crystal Arthropathies Poster I

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: There is increasing recognition of a gout epidemic, exacerbated by an unhealthy diet and a sedentary lifestyle. Indeed, our recent study among men confirmed that the Western dietary pattern was associated with an increased risk of gout (Rai et al. BMJ 2017).  In contrast, the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of gout (Rai et al. BMJ 2017).  The extrapolation of these findings to women should be done with caution given the substantial difference in uric acid metabolism, gout incidence, and role of estrogen on serum uric acid levels.  We aimed to examine the DASH, Mediterranean, and Western diets in relation to gout risk among women.

Methods: We evaluated the risk of incident gout in ~70,000 woman who reported a physician diagnosis of gout from 1984-2012.  Using dietary intake information obtained from validated Food Frequency Questionnaires, we used a previously derived DASH diet score, emphasizing fruits, vegetables, nuts and legumes, whole grains, low-fat dairy foods, and reduced intake of saturated and total fat and sugar-sweetened beverages (SSBs).  We also used a previously derived Mediterranean diet score, based on high intake of monounsaturated fat, plant proteins, whole grains, and fish, moderate intake of alcohol, and low consumption of red meat, refined grains, and sweets. Finally, we used a previously derived Western diet score, characterized by higher intakes of red and processed meats, SSBs, desserts, French fries, and refined grains. We assigned a diet score for each participant and prospectively examined the association between the diets and incident gout risk, adjusting for age, menopausal status, total energy intake, body mass index, diuretic use, hormone therapy use, hypertension, and alcohol and coffee intakes.

Results: During 28 years of follow-up, we documented 3,076 cases of incident gout.  The DASH diet score was associated with a lower risk for gout (relative risk [RR] for extreme quintiles, 0.68 [CI, 0.60 to 0.76]; P<0.001 for trend).  Similarly, the Mediterranean dietary pattern score was associated with a modestly lower risk for gout (RR for extreme quintiles, 0.86 [CI, 0.77 to 0.96]; P=0.05 for trend).  In contrast, the Western diet score was associated with an increased risk for gout (RR, 1.56 [CI, 1.37 to 1.79]; P<0.001).

Conclusion: The DASH and Mediterranean diets are associated with a lower risk of incident gout in women, although the DASH diet shows an even greater protective benefit; conversely, the Western dietary pattern is associated with an increased risk of gout.  These findings confirm the associations observed in the recent study among men and provide the first such prospective evidence among women. The DASH diet appears to offer an attractive dietary approach for gout, as it also reduces blood pressure among patients with hypertension, present in 81% of female gout patients (Zhu et al. Am J Med 2012).

 

Model

Quintile 1

Quintile 2

Quintile 3

Quintile 4

Quintile 5

P for trend

Dash Diet

 

 

 

 

 

 

No. of incident gout cases

680

700

751

393

552

Person-years of follow-up

385859

400700

464194

275779

450160

Incidence rate (1/1000PYs)

1.76

1.74

1.62

1.43

1.23

 

Age-adjusted RR

1.00 (Reference)

0.91 (0.82,1.01)

0.81 (0.73,0.90)

0.70 (0.61,0.79)

0.59 (0.53,0.66)

<.0001

Age, BMI, alcohol, and calorie-adjusted RR

1.00 (Reference)

0.92 (0.83,1.02)

0.85 (0.77,0.95)

0.77 (0.68,0.87)

0.70 (0.63,0.79)

<.0001

Multivariable-adjusted

1.00 (Reference)

0.90 (0.81,1.00)

0.83 (0.75,0.92)

0.74 (0.65,0.84)

0.68 (0.60,0.76)

<.0001

Mediterranean diet 

No. of incident gout cases

745

562

602

496

671

Person-years of follow-up

419458

340765

369724

342807

503958

Incidence rate (1/1000PYs)

1.78

1.65

1.63

1.45

1.33

 

Age-adjusted RR

1.00 (Reference)

0.95 (0.85,1.05)

0.95 (0.85,1.05)

0.84 (0.75,0.95)

0.75 (0.68,0.84)

<.0001

Age, BMI, alcohol, and calorie-adjusted RR

1.00 (Reference)

0.99 (0.89,1.11)

1.02 (0.92,1.14)

0.93 (0.83,1.05)

0.89 (0.80,1.00)

0.0338

Multivariable-adjusted

1.00 (Reference)

0.99 (0.88,1.10)

1.00 (0.90,1.12)

0.91 (0.81,1.02)

0.86 (0.77,0.96)

     0.0048

Western Diet 

No. of incident gout cases

485

591

605

620

775

Person-years of follow-up

408777

397780

390313

388145

391677

Incidence rate (1/1000PYs)

1.19

1.49

1.55

1.60

2.0

 

Age-adjusted RR

1.00 (Reference)

1.17 (1.04,1.32)

1.17 (1.04,1.32)

1.20 (1.07,1.36)

1.53 (1.37,1.72)

<.0001

Age, BMI, alcohol, and calorie-adjusted RR

1.00 (Reference)

1.13 (1.00,1.28)

1.14 (1.01,1.29)

1.19 (1.05,1.35)

1.52 (1.33,1.74)

<.0001

Multivariable-adjusted

1.00 (Reference)

1.15 (1.01,1.29)

1.16 (1.02,1.31)

1.21 (1.07,1.38)

1.56 (1.37,1.79)

<.0001

 


Disclosure: S. Keller, None; S. K. Rai, None; L. Lu, None; Y. Zhang, None; H. K. Choi, Selecta, Horizon, 5,AstraZeneca, 2.

To cite this abstract in AMA style:

Keller S, Rai SK, Lu L, Zhang Y, Choi HK. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean Diets and Risk of Gout in Women: 28-Year Follow-up of a Prospective Cohort [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-dietary-approaches-to-stop-hypertension-dash-and-mediterranean-diets-and-risk-of-gout-in-women-28-year-follow-up-of-a-prospective-cohort/. Accessed .
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