Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men

Abstract

Background: Physical activity and cardiorespiratory fitness are not currently recognized as factors related to preventing gout, nor are risk factors for gout in physically active men well understood.

Objective: The objective was to identify risk factors for gout in ostensibly healthy, vigorously active men.

Design: Incident self-reported gout was compared with baseline diet, body mass index (BMI; in kg/m(2)), physical activity (in km/d run), and cardiorespiratory fitness (in m/s during 10-km footrace) prospectively in 28,990 male runners.

Results: Men (n = 228; 0.79%) self-reported incident gout during 7.74 y of follow-up. The risk of gout increased with higher alcohol intake [per 10 g/d; relative risk (RR): 1.19; 95% CI: 1.12, 1.26; P < 0.0001], meat consumption (per servings/d; RR: 1.45; 95% CI: 1.06, 1.92; P = 0.002), and BMI (RR: 1.19; 95% CI: 1.15, 1.23; P < 0.0001) and declined with greater fruit intake (per pieces/d; RR: 0.73; 95% CI: 0.62, 0.84; P < 0.0001), running distance (per km/d; RR: 0.92; 95% CI: 0.88, 0.97; P < 0.001), and fitness (per m/s; RR: 0.55; 95% CI: 0.41, 0.75; P < 0.0001). The RR per 10 g alcohol/d consumed as wine (1.27; P = 0.002), beer (1.19; P < 0.0001), and mixed drinks (1.13; P = 0.18) was not significantly different from each other. Men who consumed > 15 g alcohol/d had 93% greater risk than abstainers, and men who averaged > 2 pieces fruit/d had 50% less risk than those who ate < 0.5 fruit/d. Risk of gout was 16-fold greater for BMI > 27.5 than < 20. Compared with the least active or fit men, those who ran > or = 8 km/d or > 4.0 m/s had 50% and 65% lower risk of gout, respectively. Lower BMI contributed to the risk reductions associated with distance run and fitness.

Conclusion: These findings, based on male runners, suggest that the risk of gout is lower in men who are more physically active, maintain ideal body weight, and consume diets enriched in fruit and limited in meat and alcohol.

FIGURE 1

Relative risk of incident gout by baseline BMI (in kg/m²) from Cox proportional hazard model in 28 990 men adjusted for age, hypertension, and daily intakes of meat, fish, fruit, alcohol, and aspirin. Additional adjustment was made for physical activity (in km/d) where indicated. P for trend is reported in parentheses. Bonferroni-corrected significant differences relative to BMI <20 kg/m² are coded as follows: * P≤ 0.05, † P≤0.01, ‡ P≤0.001, and § P≤0.0001. The 95% CIs for the risk ratios for BMI unadjusted for physical activity are 0.71 to 58.02 for BMI 20–22.5 kg/m², 1.00 to 79.00 for BMI 22.5–25.0 kg/m², 2.01 to 158.09 for BMI 25–27.5 kg/m², and 3.27 to 261.66 for BMI ≥27.5 kg/m² without km/wk adjustment.

FIGURE 2

Relative risk of incident gout by reported daily intakes of alcohol and fruit in 28 990 men from Cox proportional hazard model adjusted for age, hypertension, and weekly intakes of other foods and aspirin. Additional adjustment was made for physical activity and BMI where indicated. P for trend value is reported in parentheses. Bonferroni-corrected significant differences relative to the lowest consumptions are coded as follows: * P≤0.05, † P≤0.01, ‡ P≤0.001, and § P≤0.0001. The 95% CIs for the risk ratios for alcohol intake were 0.78 to 1.87 for 0–5 g alcohol/d, 0.70 to 1.81 for 5–10 g alcohol/d, 1.18 to 2.90 for 10–15 g alcohol/d, and 1.39 to 2.82 for >15 g alcohol/d and 0.62 to 1.33 for 0.5–1 piece fruit/d, 0.42 to 0.89 for 1–1.5 pieces fruit/d, 0.26 to 0.98 for 1.5–2.0 pieces fruit/d, and 0.33 to 0.74 for ≥2.0 pieces fruit/d unadjusted for physical activity or BMI.

FIGURE 3

Relative risk of incident gout by physical activity (running distance in km/d; N= 28,990) and by cardiorespiratory fitness (10-km footrace performance in m/s; N=24,400) and from Cox proportional hazard model adjusted for age, diet, aspirin use, and hypertension. Additional adjustment was made for BMI where indicated. P for trend value is reported in parentheses. Bonferroni-corrected significant differences relative to the slowest, least active men are coded as follows: * P ≤0.05, † P≤0.01, ‡ P≤0.001, and § P≤0.0001. The 95% CIs were 0.38 to 1.29 for 3–3.5 m/s, 0.30 to 1.00 for 3.5–4 m/s, 0.17 to 0.66 for 4–4.5 m/s, and 0.17 to 0.75 for >4.5 m/s for cardiorespiratory fitness and 0.54 to 1.21 for 2–4 km/d, 0.43 to 0.98 for 4–6 km/d, 0.31 to 0.92 for 6–8 km/d, and 0.31 to 0.81 for ≥8 km/d for physical activity without BMI adjustment.