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New research challenges belief that gout is primarily caused by diet

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Diet is much less important than genes in determining whether you’re likely to develop gout, according to a study published in the British Medical Journal.

Gout is a joint disease that causes severe pain and swelling — usually in the big toe, or fingers, wrists, elbows or knees. It is caused by excess uric acid in the blood (known as hyperuricaemia) which can lead to crystals forming around the joints.

For centuries, diet has been seen as a risk factor for the development of gout. There is certainly a link between diet and gout — recent studies suggest that certain foods (e.g. meat, shellfish, alcohol and sugary soft drinks) are associated with a higher risk of gout, while others (e.g. fruit, vegetables, low-fat dairy products and coffee) have a protective effect. Studies also show that genetic factors play an important role.

To better understand how both diet and genes might influence the development of gout, a team of researchers based in New Zealand analysed dietary survey data for 8,414 men and 8,346 women of European ancestry from five US studies.

Analysis of the participants’ diets identified seven foods associated with raised urate levels (beer, liquor, wine, potato, poultry, soft drinks and meat) and eight foods associated with reduced urate levels (eggs, peanuts, cold cereal, skimmed milk, cheese, brown bread, margarine and non-citrus fruits).

However, the analysis also showed that each of these foods accounted for less than 1% of the variation in urate levels.

Similarly, three diet scores, based on healthy diet guidelines, were also associated with lowered urate levels, while a fourth, based on a diet high in unhealthy foods, was associated with increased urate levels. Again, however, each of these diet scores explained very little (less than 0.3%) variance in urate levels, the BMJ reported.

In contrast, genetic analysis revealed that common genetic factors explained almost a quarter (23.9%) of the variation in urate levels.

While there are some limitations to the analysis, the researchers said that their findings “are important in showing the relative contributions of overall diet and inherited genetic factors to the population variance of serum urate levels”.

They conclude: “Our data challenge widely held community perceptions that hyperuricaemia is primarily caused by diet, showing for the first time that genetic variants have a much greater contribution to hyperuricaemia than dietary exposure.”