Study clarifies impact of diet on the risk of gout

March 10, 2004

A new study has clarified the role of diet in the risk of developing gout - the most common form of inflammatory arthritis in men. By taking a comprehensive look at a broad range of dietary factors, the report confirms the suspicion that consumption of purine-rich meats and seafood increases the risk of gout. It also determines that purine-rich vegetables and overall protein intake do not raise risk. Appearing in the March 11 New England Journal of Medicine, the study also finds that intake of dairy products, particularly low-fat, may be protective against gout.

"The association of purine-rich foods with gout had long been suspected but never proven," says Hyon Choi, MD, DrPH, of the Massachusetts General Hospital (MGH) Rheumatology Unit, the paper's lead author. "Any contribution of protein intake to risk was uncertain, and this is the first evidence that dairy products can be strongly protective." The report is part of the Health Professionals Follow-up Study, which is based at the Harvard School of Public Health (HSPH).

A painful condition affecting more than 5 million adults in the U.S., gout is caused by deposits of uric acid in connective tissue, often in joints of the feet or ankles, that lead to inflammatory arthritis. Symptoms include swelling, redness, stiffness, and severe pain. Although attacks of gout can subside in a few days, repeated attacks can cause permanent joint damage, and the disease often results in substantial disability, occupational limitations and frequent medical care. Treatment includes the pain-relieving drugs called NSAIDs (non-steroidal anti-inflammatories) and for more serious outbreaks, corticosteroid drugs like prednisone. Most patients with gout eventually require long-term treatment with medications that lower blood uric acid levels.

Because uric acid is formed by the breakdown of purines - compounds found in all human tissues and in many foods - gout patients have long been advised to avoid purine-rich foods. And since many animal products are rich in purines, avoidance of animal proteins has also been recommended. But the association of these foods with the risk of gout was never confirmed by prospective studies.

Initiated in 1986, the Health Professionals Follow-up Study has gathered information regarding the relationship between dietary factors and several illnesses from more than 50,000 men employed in the health professions. Every two years participants complete questionnaires regarding their diseases and health-related topics like smoking and exercise, and every four years the questionnaires also collect comprehensive dietary information.

The current investigation began with 47,000 men who did not report a history of gout at the study's outset. Participants who subsequently reported developing gout were surveyed to verify that they met standard criteria for the disorder, confirming a diagnosis of gout in 730 men by 1998. The researchers then analyzed dietary information that all study participants provided in 1986, 1990 and 1994 to determine how diet related to their risk for gout.

The study results confirmed that consumption of meat - particularly beef, pork and lamb - significantly increases the risk of gout and that consumption of all types of seafood tended to carry an even higher risk. Notably, no increased risk was seen with consumption of purine-rich vegetables - which include peas, beans, mushrooms, cauliflower and spinach - or with overall protein intake. The study actually found a potential protective effect from vegetable and dairy proteins. The protective impact of dairy products had been suggested by an earlier study finding that a dairy-free diet could increase uric acid in the blood, and the current report confirmed that increased consumption of low-fat dairy products significantly reduced the risk of gout.

Choi notes that this study's results are probably most relevant to individuals who have a history of gout or are at increased risk because of family history or other factors. "Dietary manipulation and behavioral modification to reduce risk of gout may have a much more substantial impact than currently believed. Reducing red meat consumption may be recommended because it also has been associated with such problems as colon cancer and diabetes. At the same time, healthy foods such as vegetables do not need to be restricted. Recommendations for seafood or dairy intake should be individualized with a physician or dietitian, taking into account their potential impact on any other health issues," he explains. Choi is an instructor in Medicine at Harvard Medical School.

While this study examined only men, in whom gout is more common, the investigators strongly suspect that the results would also apply to women. Future studies to investigate whether reducing meat and seafood consumption or increasing low-fat dairy intake actually prevents outbreaks in gout patients could be valuable, the researchers say.

Choi's co-authors include senior author Gary Curhan, MD, ScD, of HSPH and the Channing Laboratory at Brigham and Women's Hospital (BWH), Karen Atkinson, MD, MPH, of the MGH Rheumatology Unit; and Elizabeth Karlson, MD, and Walter Willett, MD, DrPH, of BWH and HSPH. The study was supported by grants from the National Institutes of Health and TAP Pharmaceuticals.

Massachusetts General Hospital

Related Vegetables Articles from Brightsurf:

One third of UK fruit and vegetables are imported from climate-vulnerable countries
One third of UK fruit and vegetables are imported from climate-vulnerable countries - and this is on the rise.

Eating your vegetables is easier said than done
The landmark EAT-Lancet report on food in the Anthropocene sets ambitious targets.

Research shows that the combined production of fish and vegetables can be profitable
When it comes to future food production, the combined farming of fish and vegetables through aquaponics is currently a hotly debated topic.

Sensitivity to bitter tastes may be why some people eat fewer vegetables
A gene that makes some compounds taste bitter may make it harder for some people to add heart-healthy vegetables to their diet.

Flowering mechanism in Brassica rapa leafy vegetables illuminated
Post graduate students in Kobe University's Graduate School of Agricultural Science have revealed the role of genes in controlling flowering time in the Brassica rapa family.

Offering children a variety of vegetables increases acceptance
Although food preferences are largely learned, dislike is the main reason parents stop offering or serving their children foods like vegetables.

Cooking vegetables: healthier with extra virgin olive oil
Cooking vegetables in the sofrito (sauté) with extra virgin olive oil favours the absorption and release of bioactive compounds of its traditional ingredients (garlic, onion and tomato), according to the study published in the journal Molecules about the role of gastronomy in the health-improving effects of the Mediterranean Diet.

Millions of cardiovascular deaths attributed to not eating enough fruits and vegetables
Preliminary findings from a new study reveal that inadequate fruit and vegetable consumption may account for millions of deaths from heart disease and strokes each year.

Tuck into colourful fruits and vegetables and see the light
A $5.7 billion global medical bill to restore sight for the estimated 45 million people with cataracts could be slashed in half by a diet rich in colourful fruits and vegetables, according to an international study.

Canadians' consumption of fruit and vegetables drops 13 per cent in 11 years
Two surveys taken 11 years apart show a 13-per-cent decrease in the amount of fruit and vegetables being consumed by Canadians, new University of British Columbia research has found.

Read More: Vegetables News and Vegetables Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to