Association between ketogenic diet and gout among U.S. adults with diabetes

BACKGROUND: The ketogenic diet (KD) has shown benefits in diabetes management, but its dietary composition may also increase the risk of gout. Evidence on this association in adults with diabetes remains scarce and inconsistent. METHODS: This cross-sectional study included U.S. adults with diabetes from the 2007 to 2016 National Health and Nutrition Examination Survey. Weighted multivariable logistic regression models, subgroup analysis, restricted cubic spline (RCS), and sensitivity analyses were used to evaluate the association between KD and gout. RESULTS: A total of 3947 participants were included, of whom 395 had gout. In the fully adjusted Model 3, per standard deviation increase in ketogenic diet ratio (KDR) was associated with 20% higher odds of gout [adjusted odds ratio 1.20, 95% confidence interval (CI): 1.05-1.37, P = 0.011], and participants in the highest quartile had 1.68-fold higher odds compared with those in the lowest quartile (95% CI: 1.16-2.44; P for trend = 0.006). RCS analysis revealed no evidence of non-linearity, supporting a linear association between KDR and gout (P for non-linearity = 0.812). Subgroup analyses showed consistent positive associations across most strata, with a stronger association observed in participants younger than 65 years. Results from sensitivity analyses were consistent with the main findings, confirming the robustness of the associations. CONCLUSIONS: Higher KDR was associated with a greater prevalence of gout in U.S. adults with diabetes, with stronger associations observed in participants younger than 65 years.