Men at Risk of Gout

Summarized by Robert W. Griffith, MD
July 13, 2005

Introduction

Gout affects up to 3.4 million US men, yet there is surprisingly little know about the relevance of the various risk factors for developing the disease. The picture of the red-faced, obese, wine-swilling, elderly gentleman with his gouty foot on a stool is imprinted in our minds, but how close is that to the truth? A recent study has looked at the relationships between likely risk factors and their actual importance in over 40,000 men, and reported their findings in the Archives of Internal Medicine. We summarize them below.

What was done

There are over 50,000 male dentists, optometrists, osteopaths, pharmacists, podiatrists and veterinarians enrolled in the Health Professionals Follow-up Study. The study began in 1986 when the men were aged 40 to 75; during the next 12 years information was collected twice-yearly concerning their height, weight, use of blood pressure drugs or diuretics (water pills), and their dietary intake of more than 130 foods and beverages, including alcohol.

The drug information was requested because gout has previously been reported in association with high blood pressure and the use of certain diuretics that cause an increase in blood uric acid levels.

The follow-up questionnaires asked about the diagnosis of gout, and all reported instances were confirmed (or not) using the American College of Rheumatology criteria for the disease.

All men with gout at the start of the study were eliminated from further analyses, so that only new cases occurring during the 12-year follow-up were counted. The various risk factors were analyzed for their association with the occurrence of new cases of gout, using the Relative Risk (RR) to describe the association.

What the results showed

Out of the 47,150 men who had no gout at the onset of the study and completed all the questionnaires, 730 confirmed cases of gout were diagnosed. The body mass index (BMI) values were compared for those with and those without gout, after adjusting for other factors that might influence the result. The higher the BMI, the greater the risk, as shown in the table; the lowest group of BMI-level men were used as a reference for estimating the relative risk.

A similar result was seen with weight changes. Compared with men who had maintained their weight at a fairly constant level, the RR for those who had gained 30 lb (13.5 kg) or more since the start of the study was1.99, or just about double. On the other hand, for those men who had lost 10 lb (4.5 kg) or more, the RR was 0.61 - reduced by a third.

Those men who had high blood pressure had a RR of 2.3, and those who took diuretic medication had a RR of 1.77. These two factors were independent, i.e. although diuretics were usually taken for high blood pressure, their use per se was associated with a greater risk of gout occurring. Similarly, high blood pressure was a risk factor, whether or not the patient took a diuretic.

What these results mean

Clearly, the more overweight you are, the higher your risk of developing gout. In this study, 52% of the gout cases were related to excess weight. And obesity (a BMI of 30 or more) accounted for 60% of the cases. More impressive still, weight loss reduced the risk. The conclusion is clear - here's another reason for men to maintain, or even reduce their weight.

Although dietary intake was assessed during the study, there's no mention of these findings in the article. This is a pity, as the precipitating role of certain foods (and drinks) for some individuals is well-described, but rarely quantified. Finally, these results were obtained in men; however, there's no reason to suppose they wouldn't also apply to women, though male gout sufferers outnumber women 20:1.

Source

• Obesity, weight change, hypertension, diuretic use, and risk of gout in men. HK. Choi, K. Atkinson, EW. Karkson, G. Curhan, Arch Intern Med, 2005, vol. 165, pp. 742--748

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