Diet and Gout in Men.

Date:

11-Mar-2004

Source

NEJM

Related Monographs

Consumer Data: Gout
Professional Data: Gout

Article

Gout has been defined as one of the most painful rheumatic diseases. It results when crystals of uric acid are deposited in connective tissue, joint spaces, or both, and is due to a disorder of uric acid metabolism. It is caused by either an over-production or under excretion of uric acid and is manifested by hyperuricemia, acute or chronic recurrent arthritis, and deposits of monosodium urates.

About two thirds of uric acid is eliminated through the kidneys. The remaining one third is eliminated through the GI tract as a result of the digestive process. There are a number of conditions that affect either uric acid clearance or increase its production. Therefore, a person with these conditions has a greater risk of developing gout.

The purines, from which uric acid is produced, come from three sources: diet, conversion of tissue nucleic acids, and synthesis of purine bases. The purines derived from these three sources enter a common metabolic pathway, leading to either the production of nucleic acid or uric acid. Uric acid may accumulate excessively if more is produce than is excreted.1 Several enzyme systems regulate the metabolism of purines, and a partial deficiency of one or more enzymes may be responsible for the increase in uric acid in otherwise normal individuals. Uric acid may also be overproduced as a consequence of certain metabolic disorders.

Over a 12-year period, researchers evaluated the role of diet and the risk of gout in men. This study involved 47,150 gout-free men. Dietary data was assessed every four years using a food-frequency questionnaire. Over the 12 years, 730 new cases of gout were confirmed. The researchers found that a higher intake of dairy products was associated with a lower risk of gout. Those who had higher intakes of seafood and meat had a higher risk of gout. Purine-rich vegetables were not associated with gout. The authors concluded that, “Higher levels of meat and seafood consumption are associated with an increased risk of gout, whereas a higher level of consumption of dairy products is associated with a decreased risk.”2

References

1. Hawkins DW, Rahn DW. Gout and Hyperuricemia. In: DiPiro JT, et al, eds. Pharmacotherapy, A Pathophysiologic Approach, 4th ed. Stamford, CT: Appleton & Lange; 1999.
2. Choi HK, et al. Purine-Rich Foods, Dairy and Protein Intake, and the Risk of gout in Men. NEJM. 350(11):1093-1103.