Pro‐inflammatory dietary pattern and the risk of female gout: sex‐specific findings from three prospective cohort studies

Objective We aimed to determine whether a pro‐inflammatory dietary pattern (mechanism‐based diet) is associated with incident female gout among two large cohorts of US women. Methods We prospectively followed 79,104 women from Nurses’ Health Study (NHS; 1984‐2016) and 93,454 women from NHSII (1991‐2017); 45,445 men from Health Professionals Follow‐up Study (1986‐2016) served as a comparison cohort. Validated food frequency questionnaires were used to calculate Empirical Dietary Inflammatory Pattern (EDIP; food‐based index predictive of circulating inflammatory biomarkers) scores every 4‐years. Cox proportional hazards models were used to evaluate multivariable associations between EDIP and incident, physician‐diagnosed gout. We further tested whether these associations were independent of key guideline‐based healthy eating patterns that previously showed beneficial associations with gout (i.e., Dietary Approaches to Stop Hypertension [DASH], Alternative Health Eating Index [AHEI]). Results We documented 5,425 incident female gout cases over 4,372,320 person‐years. EDIP was positively associated with female gout risk; hazard ratio (HR; 95% confidence interval [CI]) for the most vs. least pro‐inflammatory quintile was 2.02 (1.83, 2.22). Additional adjustment for BMI attenuated this association (HR=1.71 [1.55, 1.88]). Reversing the EDIP score, women in the most anti‐inflammatory EDIP quintile had largest magnitude of protective association for gout (HR=0.58 [0.53, 0.65]) compared to HRs for healthiest DASH (0.80 [0.73, 0.87]) and AHEI quintiles (0.81 [0.74, 0.89]). The magnitude of association between EDIP and male gout was substantially smaller (HR=1.24 [1.13, 1.37]; P‐heterogeneity <0.0001). Conclusion These findings support a pivotal role of inflammation as a potential modulator between diet and gout onset, particularly among women.