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Many cases of gout could be avoidable, study finds
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Many cases of gout could be avoidable, study finds

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Study highlights best way to prevent gout

Even though research has identified some preventable risk factors for gout, the impact of modifying them is uncertain.

Q: I just had my first attack of gout. What lifestyle and diet changes can I make to prevent another one?

A: Gout is a common disease. Estimates suggest that it affects nearly 4% of the adult population in the United States, and rates are rising. The most likely explanations for the rising rates of gout are an aging population and excess weight, as both are major risk factors for the disease.

Even though research has identified some preventable risk factors for gout, the impact of modifying them is uncertain. Now a study published in JAMA Network Open has found that more than three-quarters of gout cases affecting men might be completely avoidable. And since gout affects men more often than women, this finding is particularly notable.

The researchers analyzed data from nearly 45,000 men who completed detailed surveys about their health, habits and medications every two years for 25 years. Comparing those who developed gout with those who did not, four factors were identified as protective:

— Maintaining a normal body mass index (BMI).

— No alcohol consumption.

— No use of a diuretic medication (a drug that increases urination, commonly used to treat high blood pressure and other conditions).

— Following a DASH-style diet, a heart-healthy diet originally developed to counter high blood pressure.

The analysis suggested that 69% of all cases of gout in men could be avoided with these four measures. Most of this benefit applied to men who were not obese.

There are some limitations of this study. It relied on self-reporting of diet, alcohol consumption, medications, and the diagnosis of gout. It’s possible that other factors (such as genetics) could have contributed to the findings. And study participants were all male health professionals, and 91% were white, so the findings may not apply to all people at risk for gout.

These findings are important, but we don’t know how much impact they’ll actually have. Armed with this information, how many people would switch to the DASH diet? How many people who usually drink alcohol would quit? And how many overweight and obese individuals would manage to achieve and maintain a normal BMI?

Doctors often prescribe diuretics, such as hydrochlorothiazide, for people with hypertension and other health conditions. The risk of future gout is unlikely to alter this. However, there are many alternative medications available to treat hypertension. So, if gout is diagnosed in a person taking a diuretic, switching to a different drug is worth consideration.

The idea that gout can be prevented without medications is appealing. But knowing how to prevent gout and actually preventing it are two different things.

This new research adds one more reason to adopt a healthy diet, moderate alcohol intake and maintain a healthy weight: Not only might this improve your health overall, but you may also save yourself from gout.

Robert H. Shmerling, M.D., is a senior faculty editor at Harvard Health Publishing and corresponding member of the Faculty of Medicine, Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.

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