Pro-inflammatory dietary pattern and the risk of female gout: sex-specific findings from three prospective cohort studies.

Objective: We aimed to determine whether a pro-inflammatory dietary pattern (mechanism-based diet) is associated with incident female gout among two large cohorts of US women.

Methods: We prospectively followed 79,104 women from Nurses' Health Study (NHS; 1984-2016) and 93,454 women from NHSII (1991-2017); 45,445 men from 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 4-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 (i.e., Dietary Approaches to Stop Hypertension [DASH], Alternative Health Eating Index [AHEI]).

Results: We documented 5,425 incident female gout cases over 4,372,320 person-years. EDIP was positively associated with female gout risk; hazard ratio (HR; 95% confidence interval [CI]) for the most vs. least pro-inflammatory quintile was 2.02 (1.83, 2.22). Additional adjustment for BMI attenuated this association (HR=1.71 [1.55, 1.88]). Reversing the EDIP score, women in the most anti-inflammatory EDIP quintile had largest magnitude of protective association for gout (HR=0.58 [0.53, 0.65]) compared to HRs for healthiest DASH (0.80 [0.73, 0.87]) and AHEI quintiles (0.81 [0.74, 0.89]). The magnitude of association between EDIP and male gout was substantially smaller (HR=1.24 [1.13, 1.37]; P-heterogeneity <0.0001).

Conclusion: These findings support a pivotal role of inflammation as a potential modulator between diet and gout onset, particularly among women.