The Dietary Approaches to Stop Hypertension (DASH) diet is associated with a lower risk of gout, which suggests that the effect of lowering uric acid levels in patients with hyperuricemia translates to a lower risk of gout, according to a study published in the BMJ.
Sharan K Rai, BSc, from the Division of Rheumatology, Allergy and Immunology at Massachusetts General Hospital in Boston, and colleagues conducted a prospective cohort study to examine the relationship between the DASH and Western diets and risk of gout (ie, the clinical end point of hyperuricemia) in men. The participants provided information on weight, regular use of medications (including thiazides and loop diuretics), and medical conditions (including hypertension) at baseline, and every 2 years thereafter. Subjects indicated whether they had received a diagnosis of gout from a physician on a biennial questionnaire mailed to those who had reported incident gout diagnosed from 1986 onward.
The primary end point was incident gout that met 6 or more of the 11 criteria for gout (more than one attack of acute arthritis, maximum inflammation developed within one day, oligoarthritis attack, redness observed over joints, painful or swollen first metatarsophalangeal joint, unilateral first metatarsophalangeal joint attack, unilateral tarsal joint attack, tophus, hyperuricemia, asymmetric swelling within a joint [or on radiography], and complete termination of an attack).
A total of 44,444 men with no history of gout at baseline were included in the study. Using validated food frequency questionnaires, each participant was assigned a DASH dietary pattern score (based on 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 dietary pattern score (based on high intake of red and processed meats, French fries, refined grains, sweets, and desserts).
Over 26 years of follow-up, the authors documented 1731 newly diagnosed gout cases meeting the American College of Rheumatology criteria (1500 [86.7%] with podagra, 1226 [70.8%] with hyperuricemia, 605 [35.0%] with tarsal joint involvement, and 167 [9.6%] with tophi). Men in the highest fifth of DASH dietary pattern score tended to be older and had a lower BMI compared with participants in the lowest fifth. Men in the highest fifth of DASH dietary pattern score also had lower intakes of alcohol and coffee than participants in the lowest fifth. Comparatively, men in the highest fifth of Western pattern score tended to be younger, had a higher BMI, and had higher intakes of alcohol and coffee.
A higher DASH dietary pattern score was associated with a lower risk for gout (adjusted relative risk [RR] 0.68). In contrast, a higher Western dietary pattern score was associated with an increased risk for gout (RR 1.42).
“In this large prospective cohort study, we found that the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of incident gout,” said the authors. “In contrast, the Western diet was associated with an increased risk of incident gout.… These data suggest that the DASH diet could offer an attractive dietary strategy that would be useful in the prevention of gout and its comorbidities in high risk patients with hyperuricemia.”
- Rai SK, Fung TT, Lu N, et al. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ. 9 May 2017. doi: 10.1136/bmj.j1794