Abstract & Commentary
Synopsis: Diets low in red meat and fish and high in vegetables and low-fat dairy products are associated with a decrease in the incidence of gout.
Source: Choi HK, et al. N Engl J Med. 2004;350:1093-1103.
Gout is the most common form of inflammatory arthritis in men affecting approximately 3.4 million men in the United States. Patients are typically advised to avoid habitual intake of purine-rich foods such as meats, seafood, purine-rich vegetables, and animal protein (as a proxy for purines). But, as Choi and associates note, the associations have not been confirmed by prospective studies. In this study, Choi et al prospectively investigated the association of these dietary factors with new cases of gout.
Over a 12-year period they examined the relationship between reported dietary risk factors and new cases of gout among 47,150 men in the Health Professionals Follow-up Study who had no history of gout at baseline. Diet was assessed every 4 years by means of a validated food-frequency questionnaire.
During the 12-year study, they documented 730 new cases of gout. The multivariate risk of gout among men in the highest quintile of meat intake, as compared to the lowest quintile, was 1.41 (P = .02). The relative risk associated with seafood intake was 1.51 (P = .02) In contrast, the incidence of gout decreased with increasing intake of dairy products. The risk among men in the highest quintile, as compared with those in the lowest quintile, was 0.56 (P < .001).The level of purine-rich vegetables and the total protein intake were not associated with an increased risk in gout.
Interestingly the risk of gout did not vary according to body weight (except in those men with a high fish consumption) or alcohol.
Comment by Ralph R. Hall, MD, FACP
Johnson and Rideout, in their interesting editorial, point out that a diet low in meat and high in dairy products was proposed by John Locke (1632-1704), who encouraged milk drinking and "eating very little flesh but abundance of herbs."1
Johnson and Rideout also note that the Polynesians, in the Cook Islands, have relatively high serum uric acid levels despite a traditional diet low in red meats, a finding which suggests that genetic and other influences are also modulators of serum uric acid levels.
Another potentially important aspect of this study is a study by Johnson (one of the editorialists), which suggests that uric acid levels are important in the pathogenesis of hypertension.2 Supporting these conclusions is the effectiveness of the Dietary Approaches to Stop Hypertension diet in lowering blood pressure. (The DASH diet emphasizes fruits, vegetables and low fat dairy products and includes grains, poultry, nuts and small amounts of red meat, sweets and sugar containing beverages. It also contains fish).3
It becomes obvious that a Mediterranean diet, eg, the DASH diet, can not only be useful in preventing gout, but hypertension, hyperlipidemia and perhaps even certain cancers as well. An opportunity for a vast reduction in morbidity and mortality from cardiovascular disease and cancer is emerging! The benefits of following a healthy diet are staggering!
Dr. Hall, Emeritus Professor of Medicine, University of Missouri-Kansas City School of Medicine, is Associate Editor of Internal Medicine Alert.
1. Johnson RJ, Rideout BA. N Engl J Med. 2004;350:1071-1073.
2. Johnson RJ, et al. Hypertension. 2003;41:1183-1190.
3. Sacks FM, et al. N Engl J Med. 2001;344:3-10.