The following article is a part of conference coverage from the American College of Rheumatology (ACR) Convergence 2021, being held virtually from November 3 to 10, 2021. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2021.


Hyperinsulinemia, due to dietary choices, was found to be associated with increased risk for gout among US women older than 30 years; however, diets that maintained insulin sensitivity had lower gout risk, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

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Using large prospective studies, the researchers sought to examine the link between 2 distinct insulin-related dietary indices and the risk for incident gout among US women older than 30 years.

The study included women with no baseline gout from the Nurses’ Health Study (NHS) 1 (1986-2016) and 2 (1989-2017) database. Dietary intake and other external factors, along with new cases of gout, were determined by validated questionnaires every 2 to 4 years. The insulinemic potential of the diet was determined using a food-based empirical dietary index for hyperinsulinemia (EDIH), indicating insulin resistance; and dietary insulin index (DII), reflecting transient, postprandial insulin secretion.

A total of 170,699 women were included in the study, of whom 5283 incident gout cases were determined over a period of 4,317,270 person-years.

Women with higher insulin resistance, indicated by EDIH scores, had a 1.9-times greater risk for gout than women with lower insulin resistance (95% CI, 1.7-2.1). The risk remained the same when adjusted for body mass index (BMI; adjusted hazard ratio [HR], 1.5; 95% CI, 1.4-1.7). The DII scores were found to be inversely associated with gout risk (HR, 0.74; 95% CI, 0.68-0.80). Among the 2 cohorts and subgroups, EDIH effects were similar with HRs of 1.8 (1.7-2.1) and 2.1 (1.7-2.4) in the NHS 1 (mean age at baseline, 50 years; 49% postmenopausal) and NHS 2 (mean age at baseline, 36 years; 3.6% postmenopausal), respectively.

The researchers concluded, “EDIH scores, reflecting chronic hyperinsulinemia ([ie], greater insulin resistance with reduced clearance), were positively associated with the risk of incident gout in these large prospective cohorts of US women, even beyond the pathway through adiposity. Conversely, higher DII scores, which reflect short-term, postprandial elevations in insulin levels ([ie], higher insulin sensitivity) conferred a lower risk.”


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McCormick N, Yokose C, Lu N, Joshi A, Choi HK. Hyperinsulinemic diet and increased risk of female gout: 2 prospective cohort studies of US women over 30 years. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 0578.