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Background: Although gout is conventionally known as a male condition, the recent Global Burden of Disease (GBD) Study found disproportionate worsening among women.1 We have found Dietary Approaches to Stop Hypertension (DASH) diet is independently associated with a lower risk of incident gout, while Western diet is associated with increased risk.2 Whether these risks vary according to genetic risk remains unknown.

Objectives: To investigate the influence of genetic predisposition on the relation between diets (one protective and another hazardous) and gout risk in a large prospective US cohort of women over 32 years.

Methods: We examined the role of genes on the association between two dietary patterns (DASH and Western) on the risk of incident gout in 18,512 women from the Nurses’ Health Study. Using validated food frequency questionnaires, for each participant we derived: 1) DASH score emphasizing fruits, vegetables, nuts, legumes, whole grains, low-fat dairy, and reduced intake of saturated fat and sugar-sweetened beverages (SSBs) and 2) Western diet score characterized by high intake of red and processed meats, SSBs, desserts, French fries, and refined grains. A genetic risk score (GRS) was derived using 114 serum urate single nucleotide polymorphisms from the latest GWAS consortium.3

Results: There were 523 incident gout cases meeting ACR survey criteria4 (170 vs. 353 in GRS below and above the mean, respectively) (Table 1). Among women with GRS below and above the mean, the multivariable relative risks (RRs) of gout were 1.0, 1.56. 1.32, 0.89, and 0.61 (0.34 to 1.09) and 1.0, 1.0, 0.85, 0.51, and 0.68 (0.49 to 0.96), for quintiles (Q) 1 through 5 of DASH score, respectively (p for interaction = 0.69) (Table 1). For the Western diet, RRs for Q1 through 5 were 1, 1.34, 1.07, 1.33, and 1.63 (0.91 to 2.93) for those with GRS below the mean and 1.0, 1.17, 0.93, 1.27, and 1.77 (1.19 to 2.61) among those with GRS above the mean, respectively (p for multiplicative interaction = 0.64).

Table 1.

Relative Risk of Gout by Quintiles of DASH and Western Diet Score, Stratified by Mean GRS

Conclusion: In this prospective female cohort that ascertained gout with standardized criteria over 32 years, regardless of genetic predisposition, DASH diet was similarly associated with lower risk of incident gout while Western diet was associated with a higher risk. The anticipated absolute impact of diet among genetically predisposed females was larger with greater absolute risk difference. These data agree with the recent GBD Study’s recommendation for intensive dietary and anti-obesity measures for gout prevention, especially in females.1

References: [1]Xia et al., PMID 31624843

[2]Keller et al., PMID: 28487277

[3]Tin et al., PMID 31578528

[4]Wallace et al., PMID: 856219

Acknowledgements: The authors thank the participants of the NHS.

CY is supported by the Rheumatology Research Foundation Scientist Development Award and NIH T32 AR007258. HC is supported by NIH P50AR060772 and R01AR065944.

Disclosure of Interests: None declared

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