The Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower risk for incident gout, and appears to be more significant among women with a genetic predisposition to gout, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.
Although the DASH diet – a diet rich in vegetables, fruits, and whole grains – lowers serum urate and is associated with a lower risk for incident gout, limited data are available on the impact of the diet based on genetic risk.
The objective of the current study was to determine whether diet affects gout risk differently among genetically predisposed women.
Using data from 18,247 women aged older than 34 years from the prospective Nurses’ Health Study. Validated food frequency questionnaires were used to assess DASH and Western diet scores that were categorized into quintiles, with higher quintiles indicating higher adherence to these dietary patterns.
Using 114 serum urate single-nucleotide polymorphisms from the latest genome-wide association study, a genetic risk score was established, with a higher score indicating a higher genetic predisposition for hyperuricemia.
Overall, 481 women without a genetic predisposition and 859 women with a genetic predisposition self-reported a diagnosis of gout. At baseline, no difference was noted in the clinical gout risk factors between women with and without a genetic predisposition.
Among women without a genetic predisposition to gout, DASH diet was associated with lower risk for incident gout. Compared with the highest quintile of DASH diet, the relative risk for gout was 1.43, 1.48, 1.36 and 1.31 among individuals within the first, second, third and fourth quintile. Western diet was associated with increased risk for incident gout, with relative risk for quintiles 1 through 5 of 1.0, 1.18, 0.98, 1.20, and 1.58.
Among those with a genetic predisposition, the risk for gout compared with women without a genetic predisposition in the highest quintile of DASH diet, the risk for gout for quintiles 5 through 1 were 1.76, 1.72, 2.53, 3.11, and 2.79, respectively. The relative excess risk due to interaction when comparing the highest vs the lowest quintiles was 0.57 (95% CI, -0.02 to 1.17; P =.06). Western diet was associated with increased risk for incident gout, with relative risk for quintiles 1 through 5 of 1.93, 1.94, 2.01, 2.22, and 2.74.
“These data support the recent Global Burden of Disease (GBD) study’s recommendation for intensive dietary measures for gout prevention, especially in [women],” the researchers concluded.
Patients with end-stage kidney disease (ESKD) who contract the novel coronavirus disease 2019 (COVID-19) have a high mortality rate, according to findings from an early case series published in the Journal of the American Society of Nephrology.
Syed Ali Husain, MD, MPH, and colleagues from Columbia University in New York studied the presentation and outcomes among 59 patients on dialysis (57 on hemodialysis and 2 on peritoneal dialysis) admitted to their medical center with COVID-19 during March 9, 2020 to April 8, 2020. Patients had a median age of 63 years, 56% were male, and 75% were Hispanic. Most patients had other comorbidities associated with COVID-19 risk. All but 1 patient had hypertension, 69% had diabetes, 46% had coronary artery disease, 54% were overweight or obese, 17% had pulmonary disease, and 32% were current or former smokers. Five patients had a previous kidney transplant, but none were currently receiving chronic immunosuppressive therapies.
The most common presenting symptoms of COVID-19 were similar to those observed in the general population: fever (49%), cough (39%), dyspnea (36%), and fatigue/malaise (22%). Fewer patients reported gastrointestinal symptoms (15%), chills (10%), myalgia (7%), or altered mental status (8%). Initial radiographs showed multifocal or bilateral opacities in 59%, unilateral opacities in 10%, and no acute findings in 19%.
Eight patients received mechanical ventilation at a median 1.5 days from admission, 40 had no ventilation, and 11 had a “do not intubate” advanced directive.
Of the 59 patients, 18 (30.5%) died at a median 6 days after hospitalization, including 3 out of 4 mechanically ventilated patients and all 11 patients with a “do not intubate” order. Patients who died were significantly older than survivors (median age 75 vs 62 years), had a higher median Charlson comorbidity index (8 vs 7), and presented with higher white blood cell counts (median 7.5 vs 5.73 x 1000/µL) and C-reactive protein levels (median 163 vs 80.3 mg/L), the investigators reported. They acknowledged that much more data are needed before recommendations can be made.
“In conclusion, hospitalized patients with ESKD and COVID-19 displayed high mortality, although many who died had advanced directives against intubation,” Dr Hussain’s team stated. “This study reinforces the need to consider the ESKD population as a high-risk, highly vulnerable population and the need to take appropriate infection control measures to prevent the spread of COVID-19 in this group.”
Valeri AM, Robbins-Juarez SY, Stevens JS, et al. Presentation and outcomes of patients with ESKD and COVID-19 [published online May 28, 2020]. J Am Soc Nephrol. doi: 10.1681/ASN.2020040470
Yokose C, McCormick N, Lu N, Joshi A, Choi HK. Does diet affect gout risk differently among genetically predisposed women?: prospective female cohort study findings over 34 years. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 0991.
This article originally appeared on Rheumatology Advisor