Empirical dietary index for lower urate concentrations and risk of gout: evidence from cohort studies.

Background: High blood urate concentrations are a causal risk factor for the development of gout. There is no dietary pattern that specifically targets on lowering plasma urate concentrations or gout risk.

Objectives: This study aimed to derive a dietary pattern that predicts lower plasma urate concentrations and to examine this diet in relation to the risk of gout and related cardiometabolic conditions, including hypertension, coronary artery disease (CAD), stroke, and type 2 diabetes (T2D).

Methods: An Empirical Dietary Index for Normo-Uricemia (EDINU) was developed using 7-d diet records and plasma urate concentrations in the Lifestyle Validation Study (LVS) and prospective associations between the EDINU and disease risks were assessed using multivariable Cox regression in the Nurses' Health Study (NHS) and Health Professionals Follow-up Study (HPFS), using prospective cohort data. Replications were conducted in National Health and Nutrition Examination Survey (NHANES) and UK Biobank.

Results: The EDINU positively ranks low-fat milk, blueberries, grapes, and cheese as negative predictors of urate and negatively ranks mixed vegetables, liquor, red meat, liver, artificially sweetened beverages, tomato products, wine, and salad dressing as positive predictors. The EDINU showed significant correlations with plasma urate concentrations in both discovery and replication studies (Spearman correlation of -0.23 in LVS or -0.33 in NHANES). Higher EDINU scores were associated with lower gout risk in 3 independent cohort studies with a hazard ratio, comparing extreme quintiles, of 0.48 (95% confidence interval: 0.42, 0.55) in the NHS/HPFS or 0.65 (0.48, 0.88) in UK Biobank. The EDINU was inversely associated with a lower risk of hypertension, stroke, and T2D, but not CAD, in the NHS/HPFS.

Conclusions: A replicated empirical index predicting lower plasma urate is associated with significantly lower risks of gout and related cardiometabolic conditions. Consuming such a diet with lower uricemic potentials could be a novel, promising approach to preventing gout.