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The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study

BMJ 2017; 357 doi: (Published 09 May 2017) Cite this as: BMJ 2017;357:j1794
  1. Sharan K Rai, research trainee1 2 3,
  2. Teresa T Fung, professor of nutrition4 5,
  3. Na Lu, statistical analyst1 2,
  4. Sarah F Keller, rheumatology fellow1,
  5. Gary C Curhan, professor of medicine and of epidemiology2 6,
  6. Hyon K Choi, professor of medicine1 2 3
  1. 1Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
  2. 2Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  3. 3Arthritis Research Canada, Richmond, BC, Canada
  4. 4Department of Nutrition, Simmons College, Boston, MA, USA
  5. 5Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
  6. 6Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  1. Correspondence to: H K Choi hchoi{at}
  • Accepted 3 April 2017


Objective To prospectively examine the relation between the Dietary Approaches to Stop Hypertension (DASH) and Western diets and risk of gout (ie, the clinical endpoint of hyperuricemia) in men.

Design Prospective cohort study.

Setting The Health Professionals Follow-up Study.

Participants 44 444 men with no history of gout at baseline. Using validated food frequency questionnaires, each participant was assigned a DASH dietary pattern score (based on high intake of fruits, vegetables, nuts and legumes, low fat dairy products, and whole grains, and low intake of sodium, sweetened beverages, and red and processed meats) and a Western dietary pattern score (based on high intake of red and processed meats, French fries, refined grains, sweets, and desserts).

Main outcome measure Risk of incident gout meeting the preliminary American College of Rheumatology survey criteria for gout, adjusting for potential confounders, including age, body mass index, hypertension, diuretic use, and alcohol intake.

Results During 26 years of follow-up, 1731 confirmed cases of incident gout were documented. A higher DASH dietary pattern score was associated with a lower risk for gout (adjusted relative risk for extreme fifths 0.68, 95% confidence interval 0.57 to 0.80, P value for trend <0.001). In contrast, a higher Western dietary pattern score was associated with an increased risk for gout (1.42, 1.16 to 1.74, P=0.005).

Conclusion The DASH diet is associated with a lower risk of gout, suggesting that its effect of lowering uric acid levels in individuals with hyperuricemia translates to a lower risk of gout. Conversely, the Western diet is associated with a higher risk of gout. The DASH diet may provide an attractive preventive dietary approach for men at risk of gout.


  • Contributors: SKR and HKC designed the study. HKC and GCC collected the data. SKR, NL, and HKC provided statistical expertise. SKR and NL analyzed the data. SKR wrote the first draft of the manuscript. All authors interpreted the results and approved the final version of the manuscript. SKR and HKC are the guarantors.

  • Funding: This research was supported by grants R01AR065944 and UM1CA167552 from the National Institutes of Health. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization for the submitted work other than that described above; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years. HKC reports grants from AstraZeneca, consulting fees from Takeda, and consulting fees from Selecta outside the submitted work.

  • Ethical approval: This study was approved by the institutional review board of the Harvard TH Chan School of Public Health.

  • Data sharing: No additional data available.

  • Transparency: The lead authors (SKR and HKC) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that not important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

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