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Study confirms alcohol's role in increasing
risk of gout
Beer and liquor raise risk, but no
increase seen with moderate wine consumption
BOSTON - April 15, 2004 - For hundreds of years the painful
joint malady gout has been associated with overindulgence in rich
food and drink. In the April 17 issue of The Lancet, researchers
report the first study to conclusively show that certain alcoholic
beverages can significantly increase the risk of gout. But although
greater risk was associated with intake of beer and liquor, consumption
of wine did not appear to increase risk. Last month the same research
team reported
in The New England Journal of Medicine that consumption of
certain meats and seafood - but not vegetables and overall protein
- also increase the risk of gout, while dairy foods may reduce the
risk.
"It is well known that alcohol can raise levels of uric acid
in the blood, but its role in actually increasing the risk of gout
had never been confirmed," says Hyon Choi, MD, DrPH, a staff
rheumatologist
at the Massachusetts General Hospital (MGH) who led the study. "This
is the first study to confirm what we have long suspected."
The report is part of the Health
Professionals Follow-up Study, which is based at the Harvard
School of Public Health (HSPH).
A painful condition affecting more than 5 million adults in the
U.S., gout is caused by deposits of uric acid in connective tissue,
often in joints of the feet or ankles, that lead to inflammatory
arthritis. Symptoms include swelling, redness, stiffness, and severe
pain. Although attacks of gout can subside in a few days, repeated
attacks can cause permanent joint damage, and the disease often
results in substantial disability, occupational limitations and
frequent medical care. Treatment includes the pain-relieving drugs
called NSAIDs (non-steroidal anti-inflammatories) and for more serious
outbreaks, corticosteroid drugs like prednisone. Most patients with
gout eventually require long-term treatment with medications that
lower blood uric acid levels.
Initiated in 1986, the Health Professionals Follow-up Study has
gathered information regarding the relationship between dietary
factors and several illnesses from more than 50,000 men employed
in the health professions. Every two years participants complete
questionnaires regarding their diseases and health-related topics
like smoking and exercise, and every four years the questionnaires
also collect comprehensive dietary information, including alcohol
consumption.
The current investigation began with 47,000 men who did not report
a history of gout at the study's outset. Participants who subsequently
reported developing gout were surveyed to verify that they met standard
criteria for the disorder, confirming a diagnosis of gout in 730
men by 1998. The researchers then analyzed dietary information that
all study participants provided in 1986, 1990 and 1994 to determine
whether alcohol consumption had an effect on their risk for gout.
The results confirmed that alcohol intake in general was associated
with increased risk for gout. Overall the risk was 2.5 times higher
among men who consumed more than 50 grams of alcohol daily (the
equivalent of four or five drinks), and even those who consumed
as little as 10 to 15 grams a day (about one drink) had a 30 percent
increase in risk.
When the type of beverage consumed was analyzed, it was found that
intake of two or more 12-ounce beers daily increased risk 2.5-fold,
while consuming two drinks that each contained a shot of liquor
increased risk 1.6 times. No increase was seen with consumption
of two 4-ounce glasses of wine.
"While there had been some suggestion that beer might have
a greater contribution to risk, we were surprised to see such a
strong difference," Choi says. "It certainly suggests
that individuals with gout should try to limit or even cut out their
beer consumption, whereas wine may be allowed, given other health
benefits associated with moderate alcohol consumption" An instructor
in Medicine at Harvard Medical School, Choi adds that the lack of
risk associated with wine also suggests a potential direction for
future research into possibly protective components of that beverage.
Choi's co-authors include senior author Gary Curhan, MD, ScD, of
HSPH and the Channing Laboratory at Brigham and Women's Hospital
(BWH), Karen Atkinson, MD, MPH, of the MGH Rheumatology Unit; and
Elizabeth Karlson, MD, and Walter Willett, MD, DrPH, of BWH and
HSPH. The study was supported by grants from the National Institutes
of Health and TAP Pharmaceuticals.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
Information about Clinical Trials
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