For gout prevention, healthy plant-based diets are the way to go

A plant-based dietary pattern helps lower the risk of developing gout, but only when making healthy food and beverage selections, according to a study.

Analyses of large data from the Health Professionals Follow-Up Study and Nurses’ Health Study showed that simply focusing on consuming plant-based foods did not necessarily confer protection against the incidence of gout. The risk of gout was similar between participants in the highest quintile of adherence to an overall plant-based diet index (PDI) and those in the lowest quintile (pooled hazard ratio [HR], 1.02, 95 percent confidence interval [CI], 0.89–1.17; p=0.63 for trend). [JAMA Netw Open 2024;7:e2411707]

However, when PDI was distinguished between healthy and unhealthy, greater adherence to healthy PDI was associated with a 21-percent lower risk of gout (Q5 vs Q1: HR, 0.79, 95 percent CI, 0.69–0.91; p=0.002 for trend). Conversely, greater adherence to unhealthy PDI contributed to a 17-percent risk increase (Q5 vs Q1: HR, 1.17, 95 percent CI, 1.03–1.33; p=0.02 for trend), an effect that was especially pronounced in women (Q5 vs Q1: HR, 1.31, 95 percent CI, 1.05–1.62; p=0.01 for trend).

Furthermore, certain foods were either beneficial or harmful in relation to the risk of developing gout. Healthy plant food products such as whole grains (pooled HR, 0.93 per 1 serving/d, 95 percent CI, 0.89–0.97), tea and coffee (pooled HR, 0.95 per 1 serving/d, 95 percent CI, 0.92–0.97), and dairy (pooled HR, 0.86 per 1 serving/d, 95 percent CI, 0.82–0.90) were independently associated with a lower gout risk, whereas unhealthy plant food products including fruit juice (pooled HR, 1.06 per 1 serving/d, 95 percent CI, 1.00–1.13) and sugar-sweetened beverages (pooled HR, 1.16 per 1 serving/d, 95 percent CI, 1.07–1.26) were associated with a risk increase.

A total of 122,679 participants (mean age 53.8 years among 43,703 men, mean age 50.9 years among 78,976 women) were included in the analyses, with 2,709 incident cases of gout documented over 2,704,899 person-years of follow-up.

“Our findings provide the first prospective evidence, to our knowledge, that adherence to a healthy plant-based diet (ie, the healthy PDI), but not the overall PDI, was associated with a lower risk of gout, while a less healthy plant-based diet had the opposite association,” the investigators said.

“The healthy PDI shares features with the DASH and Mediterranean diets, such as an emphasis on consuming fruits, vegetables, whole grains, nuts, and legumes. This adds to the growing literature of candidate dietary patterns for gout prevention with the additional benefit of promoting broader cardiometabolic and planetary health,” they added.

There are several pathways by which plant-based diet might influence gout risk, according to the investigators. First is by improving insulin sensitivity, and second is by inducing less weight gain. Additionally, healthy plant-based diets are rich in fibre and vitamin C, which help to reduce chronic inflammation and flush out uric acid from the body, respectively. On the other hand, sugary drinks and fruit juices are high in fructose, which can trigger the body to produce more uric acid, the investigators pointed out. [Am J Clin Nutr 2019;110:574-582; Nutr Rev 2020;78:394-411; Nutrients 2021;13:701; Nutrients 2017;9:395]