Purine Foods, Dairy, Protein and Gout Risk

Choi HK, Atkinson K, Karlson EW, et al. • N Engl J Med

Key Finding

Meat and seafood increase gout risk; dairy products are protective

Original title: “Purine-rich foods, dairy and protein intake, and the risk of gout in men”

Plain English Summary

Prospective cohort study of 47,150 men showing meat and seafood increase gout risk while dairy products are protective. Total protein intake was not associated with gout risk.

In-Depth Analysis

Background

Dr. Hyon K. Choi and colleagues from Massachusetts General Hospital and Harvard Medical School published this landmark study in the New England Journal of Medicine (PMID: 15014182, DOI: 10.1056/NEJMoa035700). It was the first large prospective study examining dietary factors and gout risk.

Study Design

Population: 47,150 men from the Health Professionals Follow-up Study with no history of gout at baseline.

Follow-up: 12 years (1986-1998)

Outcome: 730 confirmed incident gout cases

Methods: Validated food frequency questionnaires assessed at baseline and every 4 years. Multivariate analysis adjusted for age, BMI, alcohol, diuretic use, hypertension, and renal function.

Key Findings

Dietary Factor	Highest vs Lowest Quintile	P for trend
Total meat	RR 1.41 (1.07-1.86)	0.02
Seafood	RR 1.51 (1.17-1.95)	0.02
Dairy products	RR 0.56 (0.42-0.74)	<0.001
Total protein	RR 1.07 (0.71-1.62)	0.41

Key finding: Total protein intake was NOT associated with gout risk—the type of protein matters.

Mechanistic Insights

Purine content alone does not explain results. Plant purines (from vegetables, legumes) showed no association with gout. Dairy proteins may lower uric acid through uricosuric effects of lactalbumin and casein.

Clinical Implications

Challenges traditional advice to avoid all high-protein foods. Meat and seafood should be moderated, but dairy consumption should be encouraged. Vegetable purines need not be restricted.

Metabolic Health Perspective

Gout is increasingly recognized as a metabolic disease. Fructose (not captured in this study) emerged later as a major driver. Moderate protein from dairy supports metabolic health while reducing gout risk.