Gout and Alcohol Intake

Summarized by Robert W. Griffith, MD
August 16, 2006

Summary

Alcohol intake - beer, and to a lesser extent spirits, but not wine - is strongly associated with an increased risk of developing gout.

Introduction

The classical picture of gout derived from earlier times is that of an elderly, red-faced man sitting with his foot up on a stool, drinking port wine. This relationship between alcohol intake and gout has been recognized since ancient times, but only recently has it been fully explored in prospective clinical studies. One of the first such prospective studies comes from the Rheumatology Unit at Massachusetts General Hospital, Boston. It was published in the medical journal Lancet, and we summarize it here.

What was done

The Health Professionals Follow-up Study has over 50,000 men enrolled - dentists, optometrists, pharmacists, etc - who were aged 40-75 in 1986. From then onward they were sent questionnaires every two years for 12 years. Those with a history of gout at baseline were excluded from further analysis.

The questionnaire requested information on the average daily alcohol intake, the type of alcohol taken, general nutrient intake, weight, medications used, and medical conditions. In particular, participants were asked to report if they had been diagnosed as having gout by a physician; those who indicated that they had, received follow-up questionnaires to confirm the finding, e.g. were gouty tophi¹ or crystals found?

Alcohol intake was adjusted to the actual grams of ethanol per day consumed. Participants were classified into 7 groups according to their average alcohol intake, and into 5 groups according to their frequency of drinking alcohol. The risk of developing gout was analyzed across total alcohol intake and frequency of drinking after adjustment for a number of factors - age, calorie intake, body mass index (BMI), diuretic use, high blood pressure, chronic kidney disease, intake of meat, seafood, purine-rich vegetables, dairy food, and fluid intake - that might influence the outcomes.

What was found

The average age of the 47,150 participants was 55; their average BMI was 25. There was an increase in the average BMI, high blood pressure, and diuretic use in the higher alcohol intake groups.

Overall, there were 730 newly diagnosed cases of gout in the participants during the 12-year follow-up period. There was an increased risk of gout in those drinking more alcohol - see the table below:

	None	10-15 g/day	15-30 g/day	30-50 g/day	over 50 g/day
Relative Risk	1.0 (set)	1.32	1.49	1.96	2.53

Using the frequency of alcohol intake figures, it was found that beer carried the greatest relative risk:

	Less than 1/month	1/month - 1/week	2 - 4/week	5/week - 1/day	More than 2/day
Beer	1.0 (set)	1.01	1.27	1.75	2.51
Spirits	1.0 (set)	1.27	1.25	1.22	1.60
Wine	1.0 (set)	0.84	0.90	0.82	1.05

Comment

Previous studies have shown an association between alcohol intake and gout, but they have either been weak from a statistical point of view, or without making allowance for other factors. What's interesting about this one is the lack of a role for wine; the classical view of relatively wealthy wine-drinkers being most susceptible seems to be wrong, unless there's a co-factor effect (e.g. red meat) which was deliberately excluded in this analysis. And, of course, the sample - health professionals - is not representative of the US population.

Gout has some features in common with the metabolic syndrome. A weight-reducing and low-glycemic diet, as used in diabetics, is beneficial in lowering blood uric acid. While elevated uric acid is partially a hereditary trait, the prevalence of gout is mainly due to environmental factors - such as alcohol intake. This puts gout into the category of those diseases where the patient can, by exerting a degree of self control, improve his situation. A switch from beer to wine may be all that it takes!

Source

• Alcohol intake and risk of incident gout in men: a prospective study. HK. Choi, K. Atkinson, EW. Karlson,  et al., Lancet, 2004, vol. 363, pp. 1277--1281

Footnotes
1. A tophus is a nodular mass of uric acid crystals. Tophi are deposited in different soft tissue areas of the body in gout. In chronic gout, nodular masses of uric acid crystals (tophi) deposit in different soft tissue areas of the body, most commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe.

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