Greater total alcohol consumption was significantly associated with an increased long-term risk for gout in adult men and women – with a stronger association in men – based on data from approximately 400,000 individuals.
Previous research linking alcohol consumption and incident gout has focused on men only or combined data from both sexes; therefore, the sex-specific associations between alcohol consumption and gout have remained unclear, wrote Jie-Qiong Lyu, MPH, of Suzhou Medical College of Soochow University, China, and colleagues.
Alcohol Consumption by Type and Gout Risk
Lyu’s study is important because questions persist as to how alcohol intake affects gout risk in men and women, and whether the risk is increased based on different types of alcohol, Theodore Fields, MD, a rheumatologist at Weill Cornell College of Medicine and the Hospital for Special Surgery, New York, told MedCentral.
The study by Lyu et al, published in JAMA Network Open, reviewed data on 401,128 adults aged 37 to 73 years who were gout-free at baseline enrollment (between 2006 and 2010). Participants were part of the UK Biobank prospective cohort study. The study population included 179,828 men and 221,300 women; both sexes had a mean age of 56 years, and approximately 96% were white.
Participants completed questionnaires on total alcohol consumption and on the specific types of alcohol consumed. They also underwent brief interviews and physical assessments, and were followed for at least 10 years to track the incidence of gout.
The main analysis included 5,278 cases of incident gout (4,096 in men and 1,182 in women). For men, current drinking was significantly associated with increased risk of gout compared to never drinkers (hazard ratio 1.69) but no similar association appeared among women (HR 0.83). Current drinkers of both sexes showed an increased risk of gout with increased total alcohol consumption, although the association was noticeably stronger in men vs. women (HR 2.05 vs. HR 1.34).
Beer or cider consumption had the strongest association with gout per pint consumed each day for both men and women (HR 1.60 and HR 1.62, respectively), but men consumed significantly more beer or cider than women (mean 4.2 pints per week vs. 0.4 points per week).
Drinking champagne or white wine and drinking spirits were associated with a higher risk of gout among both men and women as well, and a moderate association appeared between red wine consumption and gout in men.
No association with fortified wine (eg, port wine, sherry, and vermouth) and incident gout appeared for either sex.
Alcohol Intake Recommendations Shouldn’t Change Just Yet
“Overall, I think this article supports the current recommendation that people with gout, or at high risk of gout, limit all types of alcoholic drinks,” said Dr. Fields, who was not involved in the study. He emphasized, however, that the study’s limitations, along with prior data “do not permit us to change recommendations, such as advising people to drink red rather than white wine, or to advise that wine not a problem.”
Previous research has demonstrated an increased risk of gout from all types of alcohol, and examples of such studies were not apparent in the bibliography of the current study, he explained.
The overall findings that alcohol increases gout risk in both men and women were not surprising, said Dr. Fields, who was not involved in the study. “Finding that effect of alcohol on women seems to be less is hard to interpret, since women tend to get gout later in life than men, usually after the menopause,” he said.
The finding that beer and cider were the riskiest types of alcoholic drink was not unexpected, nor was the increased risk associated with white wine and spirits Dr. Fields said, but he was surprised by the lack of risk from fortified wine. Lyu’s team acknowledged the small number of people drinking fortified wine, which may have prevented detection of any association with fortified wine and gout, he noted.
Limitations and Takeaways
The findings were limited by several factors including potential confounding and the use of a database not created before participants were recruited, the researchers wrote. Other limitations included the reliance on self-reports, the assessment of alcohol consumption at baseline only, reliance on hospital records for gout information, and the homogenous study population.
However, the results suggest that the sex-specific difference in the association between drinking status or frequency and incident gout may stem in part from the sex-specific difference in type of alcohol consumed, Lyu et al concluded.
According to Dr. Fields, “additional research would be valuable if it were possible to assess ongoing alcohol intake at multiple times, rather than only at baseline as in this study. Self-reports of alcohol intake are always somewhat problematic, in this and other similar studies,” he said. “Also, incidence of gout in this study was determined by inpatient records, so that patients only diagnosed with gout as outpatients would be missed.”
Disclosures: The study was supported by the Gusu Leading Talent Plan for Scientific and Technological Innovation and Entrepreneurship. The researchers reported no financial conflicts.
Dr. Fields reported no relevant conflicts of interest.
