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  1. N. McCormick1,2,3,4,
  2. C. Yokose1,2,3,
  3. L. Lu4,
  4. A. Joshi2,3,5,
  5. H. Choi1,2,3,4
  1. 1Massachusetts General Hospital, Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Boston, United States of America
  2. 2Harvard Medical School, Medicine, Boston, United States of America
  3. 3Massachusetts General Hospital, The Mongan Institute, Boston, United States of America
  4. 4Arthritis Research Canada, Richmond, Canada
  5. 5Massachusetts General Hospital, Clinical & Translational Epidemiology Unit, Boston, United States of America


Background: Emerging evidence suggests inflammation may drive progression from hyperuricemia to clinical gout, but the role of extrinsic, modifiable sources of chronic inflammation, such as diet, on gout risk is unknown. Notably, greater dietary inflammatory potential has been independently associated with increased risk of incident cardiovascular disease (CVD)1 and type 2 diabetes (T2D).2

Objectives: Prospectively examine the relation between dietary inflammatory potential and risk of gout in three large cohorts of US women and men over 30 years.

Methods: Ascertaining the ACR survey criteria for gout for several decades,3 we studied gout risk among 164,090 women from Nurses Health Study I (1986-2016) and II (1989-2017) and 40,598 men from Health Professionals Follow-up Study (1986-2016), free of gout at baseline. Dietary intake and covariates were assessed by validated questionnaires every 4 years. Inflammatory potential of diet was evaluated using a food-based empirical dietary index of inflammatory potential score (EDIP) pre-defined based on circulating levels of IL-6, C-reactive protein, adiponectin, and TNFαR2.4

We assigned an EDIP score for each participant, adjusted for total energy take, and prospectively examined the association between quintiles of EDIP score and incident gout, adjusting for potential confounders. We also stratified by alcohol intake, as alcohol has anti-inflammatory properties,4 but is associated with a higher gout risk, particularly beer.5

Results: We documented 2,874 incident gout cases over 5,124,940 person-years of follow-up. In pooled multivariable-adjusted analyses, those in the highest EDIP quintile had 59% higher gout risk (multivariable RR 1.59; 95% CI 1.41–1.79), compared with the lowest (Table 1). This remained positive with further adjustment for BMI, a likely causal intermediate (RR 1.27, 1.12 to 1.42), and was stronger among non-drinkers (RR 2.37, 1.58 to 2.56) than drinkers (RR 1.57, 1.38 to 1.78) (Table 1).

Table 1.

Risk Ratio (95% CI) of Gout According to Quintiles of Inflammatory Diet Score, Overall and by Alcohol Use

Conclusion: Habitual pro-inflammatory dietary pattern was independently associated with higher risk of incident gout in these prospective cohorts, even beyond the pathway through adiposity. Our findings support a role for chronic inflammation in development of gout, similar to CVD1 and T2D.2 Adhering to a diet with lower inflammatory potential may modulate systemic inflammation, potentially reducing gout risk and these life-threatening comorbidities.

References: [1]Li et al. J Amer Coll Cardiology (2020) PMID 33153576

[2]Lee et al. Diabetes Care (2020) PMID 32873589

[3]Wallace et al. PMID 856219

[4]Tabung et al. PMID 27358416

[5]Choi et al. PMID 15094272

Disclosure of Interests: Natalie McCormick: None declared, Chio Yokose: None declared, Leo Lu: None declared, Amit Joshi: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, Vaxart, Grant/research support from: Ironwood, Horizon

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