T. J. Major 1, R. K. Topless 1, T. Neogi 2, C. A. Chen 2, L. K. Stamp 1, N. Dalbeth 4, Y. Zhang 5, H. K Choi 5, T. R. Merriman 1
1 University of Otago, Dunedin, New Zealand. ² Boston University, Boston, Massachusetts, United States of America. ³ University of Otago, Christchurch, New Zealand. 4 Auckland University, Auckland, New Zealand. 5 Harvard Medical School, Boston, Massachusetts, United States of America.
Introduction: Gout flares occur sporadically and onset is often associated with a trigger event. Patient leaflets commonly warn against consuming certain foods or beverages (meat, seafood, alcohol) due to this trigger effect. However, patients often avoid a much wider array of foods to prevent flare onset.
Objectives: This study aimed to assess the frequency and variety of gout flare trigger foods anecdotally reported by gout patients in New Zealand (NZ) and the United States (US).
Methods: 1,963 NZ gout patients (833 European, 1,130 Polynesian (Māori and Pacific)) were asked in an open-ended question to list the foods/drinks they consider to be gout triggers. From these lists a descriptive analysis was conducted assessing the frequency at which eleven food groups (alcohol, fish/seafood, meat, non-alcoholic beverages, dairy products, desserts/sweets, fruit, grains, legumes/nuts, tomatoes, vegetables) were mentioned. This was repeated in similar data from 885 gout patients from the US (89% European).
Results: In total 243 specific food items were mentioned by patients, with 57.3% of NZ European, 45.6% of Polynesian, and 66.1% of US gout patients reporting ≥one dietary gout flare trigger. In all three patient groups alcohol (~23%), fish/seafood (14 to 52%), and meat (14 to 33%) were the most commonly reported triggers. Other foods were mentioned by 29.8% of NZ European, 41.2% of Polynesian, and 20.7% of US patients. Of these other foods tomatoes and non-alcoholic beverages were most commonly mentioned, then vegetables and fruit.
Between the three patient groups there were significant differences in the proportion of people reporting seven of the eleven food groups as gout flare triggers. The largest difference was seen for fish/seafood, with a higher frequency in the NZ groups (European: 25.6%; Polynesian: 51.8%) compared to the US group (14.6%; P∆<0.0001). Reporting of meat or tomatoes as gout flare triggers had the next largest differences, with significantly more Polynesian individuals mentioning meat (33.3%) compared to either the NZ European or US gout patients (13.8% and 18.6%, respectively; P∆<0.0001). Tomatoes were almost exclusively mentioned by NZ patients, and more commonly by the Polynesian (18.1%) than European patients (7.8%; P∆<0.0001). Only three US gout patients (0.3%) mentioned tomatoes.
Conclusion: A wide variety of foods are considered triggers of flares by gout patients living in New Zealand or the United States. These foods primarily fall into three food groups, alcohol, fish/seafood, and meat; but other foods were also frequently mentioned. Compared to a similar study from the United Kingdom
[Abhishek et al. (2017) PLoS One 12(10): e0186096] a larger proportion of patients in NZ and the US
reported ≥ one dietary trigger of gout flares. The differences in flare reporting may reflect differences in diet or food content, cultural understandings of disease, or access to differing patient information.
Significance: This work highlights the differences in anecdotal reporting of dietary gout flare triggers between people living in different countries and between ethnic groups. It emphasises the importance of including a diverse community in gout research projects. However, this study is limited by the the open-ended data collection methods used and the results should be interpreted with caution. Future studies with a more controlled data collection methodology are needed to confirm the results reported here.