Proinflammatory Dietary Pattern and the Risk of Female Gout: Sex-Specific Findings From Three Prospective Cohort Studies.

Abstract

We aimed to determine whether a proinflammatory dietary pattern (mechanism-based diet) is associated with incident female gout in two large cohorts of US women. We prospectively observed 79,104 women from the Nurses' Health Study (1984-2016) and 94,382 women from the Nurses' Health Study II (1991-2017); 45,445 men from the Health Professionals Follow-up Study (1986-2016) served as a comparison cohort. Validated food frequency questionnaires were used to calculate Empirical Dietary Inflammatory Pattern (EDIP) (food-based index predictive of circulating inflammatory biomarkers) scores every four years. Cox proportional hazards models were used to evaluate multivariable associations between EDIP and incident, physician-diagnosed gout. We further tested whether these associations were independent of key guideline-based healthy eating patterns that previously showed beneficial associations with gout (ie, Dietary Approaches to Stop Hypertension [DASH], Alternative Healthy Eating Index [AHEI]). We documented 5,425 incident female gout cases over 4,372,243 person-years. EDIP was positively associated with female gout risk; hazard ratio (HR) (95% confidence interval [CI]) for the most versus least proinflammatory quintile was 2.02 (1.83-2.22). Additional adjustment for body mass index attenuated this association (HR 1.71 [95% CI 1.55-1.88]). Reversing the EDIP score, women in the most anti-inflammatory EDIP quintile had the largest magnitude of protective association for gout (HR 0.58 [95% CI 0.53-0.65]) compared with HRs for healthiest DASH (HR 0.80 [95% CI 0.73-0.87]) and AHEI quintiles (HR 0.81 [95% CI 0.74-0.89]). The magnitude of association between EDIP and male gout was substantially smaller (HR 1.24 [95% CI 1.13-1.37]; P-heterogeneity <0.0001). These findings support a pivotal role of inflammation as a potential modulator between diet and gout onset, particularly among women.