Gout Risk Tied to Eating Red Meat, Fish

Study finds low-fat dairy in diet lowers odds

WEDNESDAY, March 10, 2004 (HealthDayNews) -- A pioneering study nails down the dietary causes of the painful, joint-wrecking disease gout, and they turn out to be similar to those for heart disease and stroke -- with one notable exception.

Foremost, a diet rich in red meats is associated with an increased risk of gout, says a report in the March 11 issue of the New England Journal of Medicine that's based on data from the long-running Health Professionals Follow-up Study.

But eating seafood, which is known to protect against heart disease, is also associated with a higher risk of gout, the study finds. The research also acquits other foods suspected of causing gout, such as peas and spinach.

Gout affects an estimated 5 million Americans. It results from accumulated deposits of uric acid crystals in the joints. Gout can cause swelling, redness and periodic bouts of intense pain and, over the long run, significant joint damage.

The study was done because "a number of dietary factors have been suspected of causing gout, and they have never been confirmed by a comprehensive investigation," says research leader Dr. Hyon K. Choi, an attending rheumatologist at Massachusetts General Hospital.

Choi's team followed 47,150 men with no history of gout. After 12 years, 730 were diagnosed with it.

Those who consumed the highest amount of meat were 40 percent likelier to have the disease compared to those who ate the least, while those who ate the most seafood saw their risk rise 50 percent.

The study does exonerate some suspected dietary factors, Choi says. Notably, it has been thought that the risk is increased by foods rich in purine, a molecular component of uric acid, but the study disproves that belief.

"There was no increase associated with intake of peas, beans, mushrooms, cauliflower and spinach," all of which are rich in purine, Choi says.

Other findings are that low-fat dairy products decrease the risk of gout, while overall protein intake has no effect one way or the other, he says. Those whose dairy intake was highest were 44 percent less likely to contract gout, the study finds.

The incidence of gout probably is going up in the United States, since its risk is increased is related to obesity and other heart risk factors that affecting a growing number of Americans, Choi says.

But that isn't certain, since no one seems to be paying close attention. Some older studies found gout was affecting more Americans in the 1980s, as compared to earlier decades, Choi says, "but there have been no data since then."

To Dr. Richard Johnson, a professor of medicine at the University of Florida at Gainesville and co-author of an accompanying editorial, the gout report can be linked closely to heart disease.

"My editorial puts an additional spin on it," Johnson says. "The kinds of diet that lead to gout also are the kinds of diet associated with the epidemiology of cardiovascular disease."

As people in such regions as Polynesia shift to a Western-style diet, the incidence of both cardiovascular disease and gout has increased, Johnson says.

In this country, there has been a great democratization of gout, Johnson says. In the 19th century and before, gout was commonly regarded as an affliction of the affluent, with the port-drinking, stout squire being the prototypical sufferer.

"You see it much more now, not in the affluent but in all levels of society," Johnson says.

But he acknowledges that "it is hard to tell how much gout is out there. A lot of people self-medicate for it."

The relationship between seafood and gout creates a tricky issue for doctors, Choi says, since seafood is recommended as part of a heart-healthy diet.

"Recommendations for seafood should be individualized," he says.

More information

Learn about the causes and treatments of gout at the National Institute of Arthritis and Musculoskeletal and Skin Diseases or the American College of Foot and Ankle Surgeons.

SOURCES: Hyon K. Choi, M.D., Dr.P.H., attending rheumatologist, Massachusetts General Hospital, Boston; Richard Johnson, M.D., professor, medicine, University of Florida, Gainesville; March 11, 2004, New England Journal of Medicine
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