The first large epidemiological study to assess the age-old belief that alcohol consumption increases the risk of gout is published in the April 2004 issue of THE LANCET. A prospective study of nearly 50,000 men showed that beer drinking was more likely to be associated with gout than spirits; whereas moderate wine consumption was not linked to a risk of the disease.
Alcohol consumption causes hyperuricaemia (increased production of uric acid) which when deposited in joints leads to gout. The association between alcohol consumption and risk of gout has been suspected since ancient times, but has not been prospectively confirmed. Additionally, potential differences in risk of gout posed by different alcoholic beverages have not been assessed.
Hyon K Choi from Massachusetts General Hospital, USA, and colleagues prospectively assessed alcohol consumption and incidence of gout among 47000 male medical staff over a 12-year period. 730 cases of gout were confirmed throughout the study period. Alcohol consumption was assessed as the quantity consumed relative to the typical ethanol content of alcoholic drinks: 12*8 g for one can of beer, 11*0 g for a glass of wine, and 14*0 g for a shot of spirits.
Compared with people who did not drink, alcohol consumption was linked to gout risk, with higher overall consumption increasing this risk: around a 30% increased risk for daily alcohol consumption between 10 and 15g; around 50% increased risk for daily consumption between 15 and 30g; around a doubling of gout risk for consumption between 30 and 50g; and a 2*5 times increased risk for a daily alcohol consumption above 50g.
Beer consumption showed the strongest independent association with the risk of gout; consumption of spirits had a weaker association, while moderate wine consumption was not associated with increased gout risk.
Dr Choi comments: "We found differences in the risk of gout for the three alcoholic beverages. Two or more beers per day increased the risk of gout 2*5-fold compared with no beer intake, whereas the same frequency of spirits intake increased the risk by 1*6 times compared with no spirits intake. Correspondingly, beer increased the risk of gout per serving per day more than twice as much as did spirits even though alcohol content per serving was less for beer than spirits. Further, wine consumption of two 4-oz glasses or more per day was not associated with an increased risk of gout. These findings suggest that certain non-alcoholic components that vary across these alcoholic beverages play an important role in the incidence of gout. One candidate for this non-alcoholic component is the variation in purine contents among the individual alcoholic beverages. Beer is the only alcoholic beverage acknowledged to have a large purine content...Thus, the effect of ingested purine in beer on uric acid in blood might be sufficient to augment the hyperuricaemic effect of alcohol itself producing a greater risk of gout than spirits or wine. Whether there might be other non-alcoholic risk factors in beer, or protective factors in wine, remains unknown".