Meat and seafood increase risk of gout; dairy products decrease it

[Guest guest]

Rheumawire

Mar 15, 2004

Meat and seafood increase risk of gout; dairy products decrease it

Boston, MA - Patients with gout are typically advised to avoid habitual

intake of purine-rich foods such as meats, seafood, purine-rich

vegetables, and animal protein, but the association between these foods

and gout has never been confirmed by prospective studies. Now it has.

A 12-year follow-up of 47 150 men, reported in the March 11, 2004 issue

of the New England Journal of Medicine [1], found an increased risk of

gout with higher meat or seafood consumption, but not with higher

consumption of animal or vegetable protein. There was also a strong

inverse association between the consumption of dairy products,

especially low-fat dairy products, and the incidence of gout.

Furthermore, these dietary associations were independent of other

purported risk factors for gout, including high body-mass index (BMI),

older age, hypertension, alcohol use, use of diuretics, and chronic

renal failure.

Dr Hyon Choi and colleagues (Massachusetts General Hospital, Boston, MA)

conducted their investigation as part of the male Health Professionals

Follow-up Study, an ongoing longitudinal study started in 1986. In this

study, men aged 45 to 70 years working as health professionals

(dentists, pharmacists, etc) provide information every 2 years about

weight, medical conditions, and regular medications. In addition,

detailed information about diet was collected at baseline, in 1990, and

in 1994.

After excluding men who already had gout at baseline (5.6% of the

total), Choi and colleagues followed 47 150 men for 12 years and found

730 new and confirmed cases of gout. More cases were seen among the men

with the higher intakes of meat and seafood, and fewer among those with

a high intake of dairy foods. They calculated multivariate relative risk

(RR) as follows:

RR=1.41 (p for trend=0.02) for men with the highest intake of meat

(2.5 servings per day) compared with men with the lowest intake (0.5

servings/day); among individual meat items, only the intake of beef,

pork, or lamb as a main dish was associated with the increased risk of

gout.

RR=1.51 (p for trend=0.02) for men with the highest intake of

seafood (0.8 servings per day) compared with those with the lowest (0.04

servings per day).

RR=0.56 (p for trend<0.001) for men with the highest intake of

dairy products (4.2 servings/day) compared with the lowest (0.5 servings

per day), but this was limited to consumption of low-fat dairy products

(skimmed milk and low-fat yogurt).

There was no significant association found for the consumption of

purine-rich vegetables (eg, peas, beans, lentils, spinach, mushrooms,

oatmeal, and cauliflower), either individually or as a group. Nor was

there a link for total protein intake or animal-protein intake.

The study provides " clinically relevant information, " say Choi et al.

Each additional daily serving of meat was associated with a 21% increase

in the risk of gout, while each additional serving of seafood was

associated with a 7% increase in risk. This effect may be even greater

in patients who already have gout, they add.

" The effect of diet on serum uric acid levels is relevant to the

changing worldwide epidemiology of hyperuricemia and gout, " comments an

accompanying editorial [2]. Gout, once considered a disease of the

wealthy, is now associated with Westernization and its diet of fatty

meats and low dairy intake. It has become epidemic among some native

peoples, such as the Maori of New Zealand, since the introduction of

Western culture and dietary habits, whereas previously it was unknown.

An increase in the incidence of gout has also been seen among

non-Western immigrants to Western countries (eg, Filipino and Japanese

immigrants to North America) and among blacks, both those in Africa and

those in the US.

Gout should be considered as part of the current global epidemic of

obesity, hypertension, and diabetes, the editorial concludes. Diets that

are rich in fruits, vegetables, and low-fat dairy foods, such as the

Dietary Approaches to Stop Hypertension (DASH), may reduce not only

blood pressure but also the frequency of gout, it suggests.

Zosia Chustecka

Sources

1. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich

foods, dairy and protein intake, and the risk of gout in men. N Engl J

Med 2004 Mar 11; 350(11):1093-103.

2. RJ, Rideout BA. Uric acid and diet--insights into the

epidemic of cardiovascular disease. N Engl J Med 2004 Mar 11;

350(11):1071-3.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org