Four healthy diets were linked to gout prevention in women enrolled in the Nurses’ Health Study: the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Alternative Healthy Eating Index (AHEI), and Prudent diets. The DASH diet was linked to the greatest risk reduction, as reported in JAMA Internal Medicine.

“Nurse practitioners and PAs can encourage women to follow one of these diets congruent with the 2020 to 2025 Dietary Guidelines for Americans, taking into account patients’ personal food preferences and comorbidity profiles,” said coauthor Natalie McCormick, PhD, CIHR post-doctoral research fellow in rheumatology at Massachusetts General Hospital/Harvard Medical School and Arthritis Research Canada. “These diets may help with gout prevention and potentially kidney function as well as cardiometabolic diseases.”

“Importantly, 3 of the 4 diets were associated with a reduced risk of gout even in women with overweight or obesity, another major risk factor for gout, suggesting that diet quality has a role in reducing gout risk regardless of BMI,” Dr McCormick said in an interview.

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The prevalence of gout has increased at a disproportionate rate in women over the last 2 decades and is more strongly associated with key comorbidities (ie, coronary artery disease, hypertension, type 2 diabetes, and chronic kidney disease) in women than in men. This large prospective cohort study was designed to assess whether adherence to guideline-based diets is associated with the risk of new-onset gout in women.

Over 34 years of follow-up, 3890 cases of incident gout were found among 80,039 women (mean age at baseline, 50.5 years; mean BMI, 25.0). Dietary scores were derived from validated food frequency questionnaires completed every 4 years.

All 4 of the healthy dietary patterns assessed in this study were consistently associated with a lower risk of incident gout (Table). In contrast, the highest quintile adherence to the Western diet (included as an unhealthy comparator) was associated with a 49% increased risk of incident gout.

Table. Risk for Gout Among Women Most Adherent vs Least Adherent to Healthy Diets

DietMV-adjusted HRa
DASH0.68 (0.61-0.76)
Prudent0.75 (0.68-0.84)
AHEI0.79 (0.71-0.89)
Mediterranean0.88 (0.80-0.98)
HR, hazard ratio; MV, multivariate
aAdjusted for age, menopause, use of hormone therapy, history of hypertension, BMI diuretic use, alcohol intake (categorical), coffee intake, and total energy intake.

The associations between the DASH, AHEI, and Prudent diets and gout risk persisted after stratifying women by use of diuretics, obesity, and alcohol use. The Mediterranean diet had minimal or no effect on gout risk in women with overweight or obesity, but did persist for those using diuretics or who consumed alcohol.

Joint Effects of Diet Plus Diuretic Use or BMI on Gout Risk

Dr McCormick said that the analysis of the joint effects of diet with diuretic use and BMI were interesting. “We were assessing the impact of ‘isocaloric’ dietary patterns (ie, comparing diet quality alone, adjusting for total energy intake), but our findings suggest the combination of a higher-quality diet and weight loss or keeping a healthy weight could reduce a woman’s risk of developing gout even more substantially.”

“This analysis showed a 68% reduction for the most DASH-adherent women who were normal weight regardless of diuretic use and a 65% reduction for the most DASH-adherent women who were not taking diuretics regardless of BMI,” Dr McCormick said.  

Tailoring Gout Prevention Diets to Comorbidities

The findings suggest that diet selection may be guided by personal preferences and culinary traditions as well as patient comorbidities, the study authors wrote. “The DASH diet may be ideal for women with hypertension whilst the Mediterranean diet may help with lipid or glycemic control as it has been shown to improve lipid levels and markers of insulin resistance,” Dr McCormick said.

The findings are limited by the observational study design, the study authors noted. “While this study only looked at the relationship between these diets and risk of new-onset gout, not recurrent gout, the latter is an area for future research,” Dr McCormick added.

“We’d like to emphasize the pleiotropic benefits of these established, guideline-based diets,” Dr McCormick concluded. “They have been shown to reduce risk of cardiovascular disease and diabetes, and here we show they can be beneficial for gout prevention too. Women at risk for gout can follow one of these healthier, more appealing dietary patterns and potentially enjoy multiple health benefits, instead of the low-purine/low-protein diet that people with gout or hyperuricemia have traditionally been encouraged to follow.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Yokose C, McCormick N, Lu N, Joshi AD, Curhan G, Choi HK. Adherence to 2020 to 2025 dietary guidelines for Americans and the risk of new-onset female gout. JAMA Intern Med. 2022 Jan 31:e217419. doi:10.1001/jamainternmed.2021.7419