Which women are more likely to have gout?

It is only for medical professionals' reference.
Have you been recruited again? As we all know, gout is especially popular among young and middle-aged men, and the incidence of gout patients is as high as 20:1, showing a clear phenomenon of "patriarchy over women"
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The reason is not only because of the unhealthy life>
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Estrogen not only promotes the excretion of uric acid, but also inhibits the formation of crystals of uric acid in the joints.
Of course, it will not stimulate joint inflammation
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Therefore, young women rarely develop gout
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However, postmenopausal women lose the protection of estrogen, and the incidence of gout is comparable to that of men
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In the annual meeting of the American Academy of Rheumatology (ACR 2021), some abstracts focused on these issues.
It is not only the arrival of menopause that accelerates female gout, but also your inheritance in the womb, the menarche in the virgin womb, and the mature fragrance.
The reproductive period and even the long-term diet are indispensable
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Survey data of millions of postmenopausal women: Gout is a foreshadowing in their teens.
There have been few studies on reproductive factors and gout.
South Korea has conducted an analysis of a large national postmenopausal female population, including 1,076,378 people aged 40- Postmenopausal women between 69 years old, observe whether they will have gout, use the Cox proportional hazard model for analysis, and perform stratified analysis based on body mass index (BMI) and the presence or absence of chronic kidney disease (CKD)
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For these 1 million postmenopausal women, the average follow-up time was 8.
1 years, and it was found that the incidence of gout was 64,052 (incidence rate was 7.
31/1,000 person-years)
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Among them, those women whose menarche came later, menopause came earlier, and had shorter reproductive periods were associated with a high risk of gout; however, no association was observed between parity (how many births) and the incidence of gout
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In addition, the use of oral contraceptives (OC) and hormone replacement therapy (HRT) is associated with an increased risk of gout
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In the high BMI group, the association between reproductive factors and gout was not statistically significant
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In the CKD group, the use of OC and HRT had no significant effect on gout
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This suggests that shorter exposure to endogenous estrogen (later menarche, earlier menopause, and shorter fertility periods) is associated with a high risk of gout
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Conversely, increased exposure to exogenous estrogen (such as OC and HRT) is associated with an increased risk of gout
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Male gout patients can't use it, but what about female patients? Globally, the prevalence of gout in women is rising faster than that in men, but there are few data on the regulation of risk factors for gout in women
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New evidence shows that just as pro-inflammatory diets are independently associated with increased risk of cardiovascular disease (CVD) and type 2 diabetes (T2D), chronic inflammation may also accelerate the development of patients from hyperuricemia to clinical gout, but improve chronic inflammation in women Whether the external factors (such as diet) improve gout is unclear
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A prospective study in the United States evaluated the relationship between dietary inflammation potential and gout risk in two large female cohorts.
It included 77,425 women from the Nurses’ Health Study (NHS) (1986-2016) and NHS II (1989-2017).
) Of 93,454 women without gout at baseline, dietary intake and variables were determined every 2-4 years through questionnaires and new gout cases diagnosed by doctors (every 2 years)
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At the same time, the researchers used the food-based empirical dietary inflammation pattern (EDIP) score to assess the inflammatory potential of the diet, based on the circulating levels of IL-6, C-reactive protein, adiponectin, and TNFαR2
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The study recorded 5,283 gout events over 4,317,270 person-years, including 3,670 cases in the NHS (average age at baseline of 50 years; 49% of postmenopausal women) and 1,613 cases in NHS II (mean age of 36 years; 3.
6%) Postmenopausal women)
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In a pooled multivariate adjusted analysis, women in the top quintile of EDIP had almost twice the risk of gout compared with women in the bottom quintile of EDIP (MV HR 1.
9, 95% CI: 1.
7-2.
1) (Table 1)
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With the further correction of confounding factors (mainly considering BMI), the results remained consistent
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Table 1: According to the quintile of the inflammatory diet score, the risk ratio of gout events.
In this large prospective cohort of both elderly and young women, habitual pro-inflammatory diet patterns were independently associated with increased risk of gout.
, And is not affected by obesity
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The researchers said that this result will further support the role of chronic inflammation in the development of gout in women, similar to its role in CVD and T2D
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This also reminds us that adhering to an anti-inflammatory diet may regulate systemic and metabolic inflammation, which may reduce the risk of gout
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Which one is more effective for female gout patients to improve the dietary pattern? Previous studies have shown that DASH diet can reduce serum uric acid, which is associated with a lower risk of gout; Western diet is associated with increased risk (Rai BMJ 2017)
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However, whether dietary influences are affected by genetic risk remains unknown
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In the 34-year Nurse's Health Study (NHS), researchers included 18,247 female gout patients and investigated the potential interaction between genetic susceptibility and diet on the risk of female gout events
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The DASH score emphasizes fruits, vegetables, nuts and legumes, whole grains, low-fat dairy products, and reducing the intake of saturated fat and sugary beverages (SSB)
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Western diet scores are characterized by a large intake of red and processed meats, SSB, desserts, French fries and refined grains
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Researchers identified 481 self-reported gout cases in women without genetic susceptibility and 859 gout cases in women with genetic susceptibility in the NHS, and found that clinical gout risk factors were similarly distributed among women with and without genetic susceptibility at baseline
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The study finally found that regardless of genetic susceptibility, the DASH diet is associated with a lower risk of gout, while Western diets are associated with a higher risk; most notably, the DASH diet seems to have a greater impact on people with a genetic predisposition for gout.

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                       Figure 1: Regardless of the genetic susceptibility, the DASH diet is associated with a lower risk of gout, while the Western diet is associated with a higher risk.
Finally, I secretly attach the DASH diet to everyone (no thanks).
For a 2000 calorie diet, it should be Daily intake: six to eight servings of cereals, four to five servings of vegetables and fruits, two to three servings of fat-free or low-fat dairy products, six or less lean meats, poultry and fish (about 30 grams per serving), Two to three parts fat
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One week intake: four to five servings of nuts, seeds and beans, five or less sugars
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At the same time, it is recommended to consume 2300 mg of sodium per day, and the final sodium intake should be maintained at about 1500 mg
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In addition, maintaining a healthy weight, exercising at least 2.
5 hours a week, and controlling alcohol consumption are all positive for reducing and preventing high blood pressure
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                       References: [1]Does Diet Affect Gout Risk Differently Among Genetically Predisposed Women?: Prospective Female Cohort Study Findings over 34 Years-ACR Meeting Abstracts[2]Pro-Inflammatory Diet and Increased Risk of Incident Female Gout: 30-Year Prospective Cohort Study of >170,000 Pre- and Post-Menopausal US Women-ACR Meeting Abstracts[3] Association Between Female Reproductive Factors and Gout: A Nationwide Population-based Cohort Study of 1 Million Postmenopausal Women-ACR Meeting Abstracts