What is the prevalence of gout in Polynesians adhering to a traditional diet without Western influence?

Prevalence of Gout in Polynesians on Traditional Diet

The prevalence of gout in Polynesians adhering to traditional diets without Western influence was significantly lower than current rates, with evidence suggesting that Westernization of diet has contributed substantially to the current epidemic of gout in these populations. 1

Historical Context and Genetic Factors

• Polynesian populations have a genetic predisposition to hyperuricemia and gout due to a defect in renal urate handling, which reduces fractional uric acid clearance (FEur) 2
• This genetic factor affects both men and women in Polynesian populations, with men having a more pronounced reduction in renal urate clearance 2
• Despite this genetic predisposition, historical evidence suggests that gout was less prevalent before Westernization of diet and lifestyle 1

Impact of Westernization on Gout Prevalence

• A landmark study in Nauru (Micronesia) demonstrated that while hyperuricemia is likely genetic in these populations, the high prevalence of clinical gout (6.9% in men) was related to the environmental change from traditional island living to almost complete Westernization 1
• The transition from traditional diets to Western diets high in purines, alcohol, and high-fructose corn syrup has dramatically increased gout prevalence 3, 4
• Current data shows an estimated prevalence of gout in French Polynesia at 14.5%, affecting 25.5% of males and 3.5% of females - representing one of the highest rates globally 5

Traditional vs. Western Dietary Factors

• Traditional Polynesian diets were typically:

  • Lower in purines from processed meats and certain seafoods 3
  • Free from high-fructose corn syrup and sugar-sweetened beverages 4
  • Lower in alcohol, particularly beer and spirits which significantly raise uric acid levels 6
  • Higher in fresh fruits, vegetables, and unprocessed foods 4

• Modern Western dietary factors that contribute to gout include:

  • High purine intake, particularly from processed meats 3
  • Sugar-sweetened beverages and foods containing high-fructose corn syrup 3, 4
  • Increased alcohol consumption, especially beer 3, 6
  • Higher overall caloric intake leading to obesity, which is independently associated with gout 3

Current Understanding and Implications

• The current epidemic of gout in Polynesian populations represents an interaction between genetic predisposition and environmental factors 5, 2
• In multivariable analysis of French Polynesian adults, factors associated with gout include age, male sex, elevated serum urate, type 2 diabetes, obesity, and increased visceral fat percentage 5
• Māori and Pacific people experience earlier onset of gout (by approximately 9 years), higher flare frequency, and more features of joint inflammation compared to non-Māori/Pacific populations 7
• Despite greater use of allopurinol, Māori and Pacific patients have higher serum urate concentrations, suggesting challenges in disease management 7

Clinical Implications

• Recognition of the dramatic impact of Western diet on genetically predisposed populations should guide preventive strategies 1, 7
• Weight management is particularly important for Polynesian populations with gout, as obesity increases with age and compounds genetic risk factors 2, 3
• Territorial measures focused on increasing access to effective urate-lowering therapies are warranted to address this major public health problem in Polynesian populations 5
• Healthcare providers should be mindful when discussing dietary habits with patients to avoid stigmatization, as patients frequently feel stigmatized when discussing gout 3

The evidence clearly demonstrates that while Polynesian populations have a genetic predisposition to hyperuricemia, the epidemic of clinical gout emerged primarily after Westernization of diet and lifestyle, suggesting that adherence to traditional diets was protective despite genetic risk factors 1, 5.