OP0203 GENE-DIET INTERACTION ON THE RISK OF INCIDENT GOUT AMONG WOMEN – PROSPECTIVE COHORT STUDY OVER 32 YEARS

Abstract

Background:Although gout is conventionally known as a male condition, the recent Global Burden of Disease (GBD) Study found disproportionate worsening among women.1 We have found Dietary Approaches to Stop Hypertension (DASH) diet is independently associated with a lower risk of incident gout, while Western diet is associated with increased risk.2 Whether these risks vary according to genetic risk remains unknown.Objectives:To investigate the influence of genetic predisposition on the relation between diets (one protective and another hazardous) and gout risk in a large prospective US cohort of women over 32 years.Methods:We examined the role of genes on the association between two dietary patterns (DASH and Western) on the risk of incident gout in 18,512 women from the Nurses’ Health Study. Using validated food frequency questionnaires, for each participant we derived: 1) DASH score emphasizing fruits, vegetables, nuts, legumes, whole grains, low-fat dairy, and reduced intake of saturated fat and sugar-sweetened beverages (SSBs) and 2) Western diet score characterized by high intake of red and processed meats, SSBs, desserts, French fries, and refined grains. A genetic risk score (GRS) was derived using 114 serum urate single nucleotide polymorphisms from the latest GWAS consortium.3Results:There were 523 incident gout cases meeting ACR survey criteria4 (170 vs. 353 in GRS below and above the mean, respectively) (Table 1). Among women with GRS below and above the mean, the multivariable relative risks (RRs) of gout were 1.0, 1.56. 1.32, 0.89, and 0.61 (0.34 to 1.09) and 1.0, 1.0, 0.85, 0.51, and 0.68 (0.49 to 0.96), for quintiles (Q) 1 through 5 of DASH score, respectively (p for interaction = 0.69) (Table 1). For the Western diet, RRs for Q1 through 5 were 1, 1.34, 1.07, 1.33, and 1.63 (0.91 to 2.93) for those with GRS below the mean and 1.0, 1.17, 0.93, 1.27, and 1.77 (1.19 to 2.61) among those with GRS above the mean, respectively (p for multiplicative interaction = 0.64).Table 1.Relative Risk of Gout by Quintiles of DASH and Western Diet Score, Stratified by Mean GRSDASHBelow MeanAbove MeanQ1Q2Q3Q4Q5Q1Q2Q3Q4Q5P InteractionNo. Cases27495121227589903465Person-Years39208472475722734953587643981545853554013473356521Age-Adjusted RR1.0 (ref)1.43 (0.89, 2.29)1.22 (0.76, 1.96)0.8 (0.45, 1.42)0.5 (0.28, 0.88)1.0 (ref)0.97 (0.72, 1.33)0.79 (0.58, 1.07)0.47 (0.31, 0.70)0.54 (0.39, 0.76)0.73MV-Adjusted* RR1.0 (ref)1.56 (0.97, 2.51)1.32 (0.82, 2.12)0.89 (0.50, 1.59)0.61 (0.34, 1.09)1.0 (ref)1.0 (0.73, 1.37)0.85 (0.63, 1.17)0.51 (0.33, 0.76)0.68 (0.49, 0.96)0.69WesternBelow MeanAbove MeanQ1Q2Q3Q4Q5Q1Q2Q3Q4Q5P InteractionNo. Cases21362839465270567699Person-Years47397493484783747589452834552947913473574644785Age-Adjusted RR1.0 (ref)1.49 (0.86, 2.56)1.26 (0.71, 2.23)1.71 (1.00, 2.93)2.22 (1.31, 3.74)1.0 (ref)1.21 (0.85, 1.74)0.98 (0.67, 1.43)1.35 (0.94, 1.93)1.88 (1.34, 2.65)0.72MV-Adjusted* RR1.0 (ref)1.34 (0.78, 2.32)1.07 (0.60, 1.90)1.33 (0.76, 2.34)1.63 (0.91, 2.93)1.0 (ref)1.17 (0.81, 1.68)0.93 (0.63, 1.38)1.27 (0.87, 1.84)1.77 (1.19, 2.61)0.64*Adjusted for age (continuous), menopause, use of hormone therapy (never, past or current), history of hypertension, systolic and diastolic blood pressure (continuous), alcohol (continuous), total energy intake (continuous), and intake of meat, seafood, and dairy foods (continuous).Conclusion:In this prospective female cohort that ascertained gout with standardized criteria over 32 years, regardless of genetic predisposition, DASH diet was similarly associated with lower risk of incident gout while Western diet was associated with a higher risk. The anticipated absolute impact of diet among genetically predisposed females was larger with greater absolute risk difference. These data agree with the recent GBD Study’s recommendation for intensive dietary and anti-obesity measures for gout prevention, especially in females.1