Is Gout associated with a healthy or unhealthy plant-based diet?

4% of the adults in the United States of America are affected by Gout. It is one of the most common inflammatory arthritis associated with an increased co-morbidity burden, premature mortality and negative mental health outcomes.

Plant-based diets are proving to be increasingly beneficial in the management of several diseases. A large-sampled prospective cohort study published recently by JAMA network open explores association between healthy or unhealthy plant-based diets and Gout. 

COHORT DATA

The study used data from population-based cohorts of USA men and women who were gout free at the beginning of the study. They were enrolled in the Health Professionals follow-up study (1986-2012) and Nurses` Health Study (1984-2010) 

Participants dietary information was collected every 4 years using semiquantitative food frequency questionnaire, the validity and reproducibility of which has been established earlier in other studies.  (https://doi.org/10.1093/oxfordjournals.aje.a116211) 

Does plant-based diet really help to reduce the risk of getting gout? 

The researchers found that “adherence to an overall plant-based diet, not distinguished between healthy and less healthy plant foods, was not associated with gout.” 

However, based on their dietary assessment and plant-based indices, they found out:

• Higher intake of a healthy plant-based diet which included whole grains, coffee, tea, dairy products, sweets and desserts were associated with lower gout risk and 
• Unhealthy plant-based foods that were positively associated with risk of gout included fruit juices, sugar-sweetened beverages, and fish. 

The research also highlighted that DASH (the Dietary Approaches to Stop Hypertension) and Mediterranean diets are linked to lower serum urate and gout risk. 

NOTEWORTHY TAKE-AWAYS FOR GOUT SUSCEPTIBILITY

Out of the total participants of this research, 2709 confirmed incident gout. 

• The researchers found a more apparent association of gout risk in women than men with unhealthy plant-based diets. Decreased risk of gout was more apparent in women than men with a healthy plant-based diet. 
• Younger participants of this study were found to be less active, with lesser consumption of Vitamin C and higher consumption of unhealthy plant-based diet. On the other hand, older participants were physically more active, consumed more Vitamin C and a healthy plant-based diet. 
• The research findings stood as is, even after the authors adjusted for several potential confounders. 

Implications of the research in clinical practice

The researchers conclusively support healthy plant-based dietary intake which shares features with the DASH and Mediterranean diets. They claim that by following such diets, it not only reduces gout incidence, but also gives the additional benefit of promoting broader cardiometabolic and planetary health. 

LIMITATIONS

As per the researchers, this was the first study done to evaluate the role of a plant-based diet in association with gout. The researchers suggest a possibility of measurement error, no objective measurement of urate, residual confounding, and subjective categorization of plant foods into healthy and unhealthy for the purpose of this research.

Due to the participants being predominantly white USA-based health professionals, generalizability of the findings are limited. 

SOURCE

The main author of this research is Qi Sun, MD, ScD, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

The research paper was published on JAMA Network open on 21^st May 2024. (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818869)