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The Health Professionals Follow-up Study

Hyon K. Choi, MD, DrPH; Karen Atkinson, MD, MPH; Elizabeth W. Karlson, MD; Gary Curhan, MD, ScD

Arch Intern Med. 2005;165:742-748.

Background  Limited prospective information exists on the relation between obesity and weight change and the risk of gout. Similarly, both hypertension and diuretic use have been considered risk factors for gout; however, their independent contributions have not been established prospectively.

Methods  We prospectively examined over a 12-year period (1986-1998) the relation between adiposity, weight change, hypertension, and diuretic use and incident gout in 47 150 male participants with no history of gout at baseline. We used a supplementary questionnaire to ascertain the American College of Rheumatology criteria for gout.

Results  During 12 years we documented 730 confirmed incident cases of gout. Compared with men with a body mass index (BMI) of 21 to 22.9, the multivariate relative risks (RRs) of gout were 1.95 (95% confidence interval [CI], 1.44-2.65) for men with a BMI of 25 to 29.9, 2.33 (95% CI, 1.62-3.36) for men with a BMI of 30 to 34.9, and 2.97 (95% CI, 1.73-5.10) for men with a BMI of 35 or greater (P for trend <.001). Compared with men who had maintained their weight (±4 lb) since age 21 years, the multivariate RR of gout for men who had gained 30 lb or more since age 21 years was 1.99 (95% CI, 1.49-2.66). In contrast, the multivariate RR for men who had lost 10 lb or more since the study baseline was 0.61 (95% CI, 0.40-0.92). The multivariate RRs of gout were 2.31 (95% CI, 1.96-2.72) for the presence of hypertension and 1.77 (95% CI, 1.42-2.20) for diuretic use.

Conclusions  Higher adiposity and weight gain are strong risk factors for gout in men, while weight loss is protective. Hypertension and diuretic use are also important independent risk factors for gout.

Author Affiliations: Rheumatology Unit, Department of Medicine, Massachusetts General Hospital (Drs Choi and Atkinson), and Division of Rheumatology (Dr Karlson) and Channing Laboratory (Dr Curhan), Brigham and Women’s Hospital, Harvard Medical School; and Department of Epidemiology, Harvard School of Public Health (Drs Choi and Curhan); Boston, Mass.

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