What are the factors that predispose some individuals to developing gout (hyperuricemia) while others do not?

From the Guidelines

Gout occurs in some people and not others due to a combination of genetic and lifestyle factors that lead to high uric acid levels in the blood, with the most significant risk factors being diet, obesity, and certain medical conditions. According to the 2016 updated EULAR evidence-based recommendations for the management of gout 1, people develop gout when their bodies either produce too much uric acid or cannot efficiently eliminate it through the kidneys, causing urate crystals to form in joints.

Key Risk Factors

• Genetic factors play a significant role, as certain inherited traits affect uric acid metabolism and excretion
• Lifestyle factors that increase risk include:
  • Consuming purine-rich foods (red meat, organ meats, seafood)
  • Drinking alcohol (especially beer)
  • Consuming fructose-sweetened beverages
  • Being overweight
• Medical conditions like hypertension, diabetes, kidney disease, and metabolic syndrome also raise gout risk
• Certain medications, including diuretics, low-dose aspirin, and some immunosuppressants, can trigger gout attacks

Reducing Gout Risk

To reduce gout risk, it is recommended to:

• Maintain a healthy weight
• Limit purine-rich foods and alcohol
• Stay hydrated
• Manage underlying health conditions
• Consider lifestyle modifications, such as weight loss, regular exercise, and a balanced diet, as supported by studies that have confirmed the effectiveness of these interventions in reducing serum uric acid levels and improving outcomes in patients with gout 1

From the Research

Risk Factors for Gout

The development of gout is influenced by a combination of nonmodifiable and modifiable risk factors.

• Nonmodifiable risk factors include:
  • Male sex 2, 3, 4
  • Obesity 2, 3, 4
  • Hypertension 2, 3, 4
  • Chronic kidney disease 2, 3
  • Certain ethnic groups, such as Taiwanese, Pacific Islander, and New Zealand Maori 2
• Modifiable risk factors include:
  • Diet rich in meat and seafood 2, 4
  • Alcohol intake 2, 4
  • Diuretic use 2
  • Diet heavy in fructose-rich food and beverages 2

Role of Diet in Gout Development

Dietary factors play a significant role in the development of gout, with certain foods and nutrients increasing the risk of gout.

• A diet rich in purine-containing foods, such as meat and seafood, can increase uric acid production and contribute to gout development 5, 2, 4
• Fructose-rich foods and beverages can also increase uric acid production and contribute to gout development 2
• On the other hand, certain nutrients, such as those found in dairy products and coffee, may have a protective effect against gout 5

Uric Acid Metabolism and Gout

Uric acid metabolism plays a crucial role in the development of gout.

• Hyperuricaemia, or elevated uric acid levels, is a prerequisite for gout development 3
• The deposition of urate crystals in joints and tissues leads to the characteristic symptoms of gout, including swelling, pain, and tenderness 6, 2, 3
• Reducing serum urate levels through medication or dietary modifications can help prevent gout flares and manage the condition 5, 6, 3