Background The Dietary Approaches to Stop Hypertension (DASH) diet, which reduces blood pressure and is recommended in cardiovascular disease (CVD) (1,2), has also been found to lower serum uric acid (SUA) levels, particularly among those with hyperuricemia (3). Thus, the DASH diet may be particularly useful in gout care by reducing both SUA and CVD risk, especially among patients with hypertension which affects 74% of gout patients (4), thereby “killing two birds with one stone”. However, corresponding data for the risk of gout are not available. In contrast, a Western dietary pattern may increase the risk of gout.

Objectives To prospectively examine the relation between the DASH and Western dietary patterns and the risk of gout among men.

Methods Using the Health Professionals Follow-up Study, we prospectively examined the relation between the DASH and Western diets and incident gout in 44,444 male participants with no history of gout at baseline. Using validated food frequency questionnaires, each participant was assigned a DASH score (reflecting high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains, and low intake of sodium, sweetened beverages, and red and processed meats) and a Western pattern score (reflecting higher intake of red and processed meats, French fries, refined grains, sweets, and desserts). We identified incident cases of gout meeting the preliminary ACR survey criteria for gout, adjusting for potential confounders including age, total energy intake, body mass index (BMI), diuretic use, history of hypertension, history of renal failure, and intake of alcohol and coffee. We conducted stratified analyses to evaluate whether the association between the DASH and Western pattern scores and the risk of gout varied according to BMI, alcohol use, and hypertension status.

Results During 26 years of follow-up, we documented 1,731 confirmed cases of incident gout. A higher DASH score was associated with a lower risk for gout (multivariable relative risk [RR] for extreme quintiles, 0.68 [95% confidence interval, 0.57 to 0.80]; P for trend <0.001) (Table 1). In contrast, a higher Western pattern score was associated with an increased risk for gout (multivariable RR for extreme quintiles, 1.42 [95% confidence interval, 1.16 to 1.74]; P for trend=0.005) (Table 1). These associations persisted regardless of BMI, alcohol use, and hypertension status, and there was no significant interaction with these variables (all P for interaction >0.17).

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Conclusions The DASH dietary pattern is associated with a lower risk of gout, suggesting that its urate-lowering effect among hyperuricemic individuals translates to a lower risk of gout. Conversely, the Western dietary pattern is associated with a higher risk of gout. The DASH diet may provide an attractive preventive dietary approach for the risk of gout, particularly given the high level of cardiovascular comorbidities among this patient population.

References

1. N Engl J Med. 1997;336(16):1117–24.

2. N Engl J Med. 2010;362(22):2102–12.

3. Arthritis Rheumatol. 2016;68(12):3002–3009.

4. Am J Med. 2012;125(7):679–687.

References

Acknowledgements This research was supported by NIH grant R01AR065944.

Disclosure of Interest None declared