Journal reading

Vegetarian diet and risk of gout in two

separate prospective cohort
studies

Chiu, Tina H.T, Liu C.H, Chen C, et all.

Clinical Nutrition 2019

INTRODUCTION
 Gout is the most common inflammatory joint disease and
an important risk factor for cardiovascular diseases,
hypertension, kidney diseases, diabetes, all-cause and
cardiovascular mortality.
 The prevalence of gout has doubled or tripled in many
countries in the past decades making gout a public
health threat that desperately needs preventive
strategies.
 Taiwan is especially affected, with one of the highest
incidences and prevalences of gout in the world.
Picture 1. Pathogenesis of hyperuricemia
Picture 2. Pathogenesis of hyperuricemia
 Gout

Restriction of
Reduce
purine and
incident
inflammation

Lower uric acid

Vegetarian diet
concentration

Picture 3. Objective
THE JOURNAL
 Introduction
 Gout is the most common inflammatory joint disease and
an important risk factor for cardiovascular diseases,
hypertension, kidney diseases, diabetes, all-cause and
cardiovascular mortality.
 Taiwan is especially affected, with one of the highest
incidences and prevalences of gout in the world
 Several cross-sectional studies found that lacto-ovo
vegetarians tend to have lower uric acid concentrations
than nonvegetarians in Taiwan, Hong Kong, and the
United Kingdom.
 Methods

Participant
Research Statistical
design analysis
Cohort 1 Cohort 2

Prospective
12,062 certified • independent
design in two
6002 participants Tzu Chi sample t-test
separate
among whom volunteers of
cohort studies • Chi-square test
77% were the Buddhist
from the Tzu
certified Tzu Chi Tzu Chi
Chi
volunteers Foundation
population

Picture 4. Methods
 Inclusion and Exclusion
No National Gout diagnosis
Health Certified Tzu Chi volunteers or their before enrollment
Insurance data families

comprehensive
health examination

Age < 20
interviewed by trained
research assistants

questionnaire
on vegetarian
dietary practice
Age > 80 and food
frequency Baseline missing the
questionnaire date of birth or sex

Picture 5. Inclusion and Exclusion Criteria of This Study

 Statistical Analyses
independent sample
Wilcoxon sign Hazard
t-test and Chi- General linear model
rank test ratios
square test

Baseline characteristics sex-specific uric

Cox
between vegetarians and acid concentrations
food/nutrient Regression
nonvegetarians among vegans,
intakes between vegetarians and
vegetarians and nonvegetarians
nonvegetarians

Potential confounders adjusted ICD-9

Picture 6. Statistical Analyses of this study

Result
Table 1. Baseline characteristics of vegetarian and
nonvegetarian in cohort 1 and cohort 2
Table 2. Dietary intakes of vegetarians and nonvegetarians as
assessed by food freaquency questionnaire in cohort 1
Table 3. Hazard ratio of gout in vegetarians vs nonvegetarians
Figure 1. Serum uric acid concentration by sex and diet in
cohort 1 participants
 Discussion

 The protective association  Partially attributed to uric acid lowering

between a vegetarian diet and
gout
 High-soy contents
 Strength of journal
 May go beyond uric acid
Taiwanese vegetarian dietary pattern
appear to be safe
religion and related lifestyle is
minimized
 The availability of detailed medication
 Bias due to loss to follow-up is minimal.

Picture 7. Discussion
 Conclusion
This is the first to discover that a vegetarian diet is
associatied with a reduced risk of gout and that the
protective association may potentially extend beyond
just the lower prevalence of hyperuricemia.

Dietary strategies for gout prevention and management

may use a healthy plant based dietary pattern as the
foundation.

This will need to be tested in randomized controlled

trials.
Thank You