Dietary Scores Linked to Prevalent Gout in Adults With Diabetes
Key Takeaways
- Among US adults with diabetes, higher HEI-2020, DASH, and aMED scores were significantly associated with lower odds of prevalent gout.
- Exploratory statistical mediation linked TyG-WHtR to the DASH and HEI-2020 associations, serum uric acid to aMED, and NLR to all three.
- Dietary-score associations showed no detected nonlinear trends or significant subgroup interactions.
Investigators conducted the dietary-pattern study as a cross-sectional, survey-weighted secondary analysis of six cycles of the National Health and Nutrition Examination Survey (NHANES) in the United States (US) from 2007–2018. The sample included 5,067 adults with diabetes, including 561 with gout, for a reported gout prevalence of 10.5%. Diabetes was identified through laboratory criteria, reported clinician diagnosis, or diabetes medication; gout was based on reported clinician diagnosis.
Scores derived from 24-hour dietary recalls were the Healthy Eating Index-2020 (HEI-2020), Dietary Approaches to Stop Hypertension (DASH), alternate Mediterranean diet score (aMED), Dietary Inflammatory Index (DII), and Alternative Healthy Eating Index (AHEI). Fully adjusted survey-weighted logistic models estimated odds ratios (ORs) per one standard deviation (SD) higher score, accounting for demographic and lifestyle factors, energy intake, comorbidities, and medication use. Investigators also examined splines and subgroups, and conducted exploratory survey-weighted product-of-coefficients mediation on the log-odds scale. Estimated glomerular filtration rate (eGFR) was evaluated as a possible mediator. No randomized dietary assignment or follow-up for new gout occurred.
Higher HEI-2020 and DASH scores corresponded to lower adjusted odds of prevalent gout. For HEI-2020, the OR was 0.82 per one SD higher score, with a 95% confidence interval (CI) of 0.70–0.96; the corresponding DASH OR was 0.83. The main findings did not identify independently significant adjusted associations for DII or AHEI.
The aMED OR was 0.86 per one SD higher score. In exploratory mediation analyses, the triglyceride-glucose–waist-to-height ratio (TyG-WHtR) statistically accounted for 40.2% (95% CI 2.1%–78.3%) of the DASH association. TyG-WHtR also showed statistical mediation for HEI-2020, serum uric acid for aMED, and the neutrophil-to-lymphocyte ratio (NLR) for all three associated dietary patterns. Splines found no nonlinearity, and subgroup interaction tests were not significant despite selected subgroup-specific estimates. Multiple-imputation findings were broadly consistent.
Diet and gout were assessed at the same time, so gout could have influenced reported eating patterns. The associations cannot establish whether diet preceded gout or demonstrate gout prevention, reduced incidence, or causal metabolic pathways. Dietary recall and self-reported gout introduce potential measurement error; residual confounding and missing mediator data further complicate interpretation. Subgroup and mediation tests were exploratory and lacked multiplicity correction, making borderline nominal findings particularly uncertain. Statistical mediation involving serum uric acid does not establish improved kidney function.
According to the authors, higher HEI-2020, DASH, and aMED scores were associated with less prevalent gout among US adults with diabetes. Metabolic, inflammatory, and urate markers offered exploratory statistical associations, not established mechanisms.
Clinician Questions
Did the dietary-pattern analysis of gout in diabetes distinguish type 1 from type 2 diabetes?
Investigators included US adults meeting laboratory, reported clinician-diagnosis, or diabetes-medication criteria for diabetes, but did not distinguish type 1 from type 2 diabetes. Associations with prevalent gout apply to the combined population, not separately demonstrated associations by diabetes type.
Do lower odds of prevalent gout with higher dietary scores in diabetes mean lower absolute gout risk?
Among US adults with diabetes, the dietary-score associations describe adjusted odds of already present, self-reported gout, not the absolute risk of developing gout. The investigators cautioned that odds ratios do not convey absolute risk and can overestimate relative risk when an outcome is common.
Recommended Reading
- For more on gout and related outcomes: Gout Linked to Higher Fracture Rates, Less Bone-Protective Therapy
This content is intended for healthcare professionals for educational purposes. The article and its image were developed with AI assistance and reviewed by members of the ReachMD team prior to publication. Please refer to the original source linked for the complete and most up-to-date information.