Risk Factors for Gout Among Women

描述（由申请人提供）：痛风是一种常见的、疼痛难忍的炎性关节炎，与高尿酸血症有关。这种情况代表了一种重要的关节炎类型，可以通过饮食和生活方式的改变来基本控制。尽管在过去的20年中女性痛风的发病率翻了一番，特别是在老年女性人群中，痛风的患病率很高，但女性痛风的危险因素仍然未知。最近，我们在一项大型前瞻性研究中阐明了传统怀疑的饮食和其他因素对男性痛风风险的作用。然而，由于尿酸代谢，性激素的作用和痛风的频率存在重要的性别差异，因此痛风的风险因素在性别之间可能存在很大差异。我们建议在我们以前对男性痛风的研究基础上，全面扩展我们对护士健康研究（n = 121，700）中女性痛风危险因素的前瞻性研究。首先，我们将前瞻性研究传统怀疑的危险因素与痛风发病风险之间的假设关系：1）肥胖、体重增加、肉类、海鲜和酒精（啤酒和白酒，但不包括葡萄酒）摄入、高血压和利尿剂使用的风险增加; 2）体重减轻和乳制品摄入的风险降低; 3）绝经后激素使用的风险降低。其次，我们将研究与痛风新风险因素的关系：1）含糖软饮料和果糖摄入增加风险; 2）咖啡摄入降低风险; 3）维生素C摄入降低风险。在拟定的2年研究期间，我们将继续根据美国风湿病学会（ACR）调查痛风标准确认痛风事件病例。我们的初步分析将涉及多变量建模，以检查这些潜在的危险因素和女性痛风发病率之间的独立关联。目前建议的重要性和优点包括：1）与常见风湿性疾病的紧迫疾病负担相关（即女性痛风的重要预防选择），2）我们在痛风研究中的经验，3）大样本量为建议的估计提供了高精度和功效，4）前瞻性事件结局分析，以及5）使用公认的，验证数据。这项研究将提供独特的，以人群为基础的，前瞻性的数据，特别是女性痛风的常见可改变的危险因素。这些目标将填补我们对女性痛风知识的重要空白，痛风是一种常见且痛苦不堪的疾病，疾病负担不断增加。公共卫生相关性：尽管在过去的20年里，女性痛风新发病例的发病率翻了一番，而且其疾病负担很大，特别是在老龄化的女性人口中，但女性痛风的风险因素仍然未知。由于雌激素对尿酸代谢的作用以及男性和女性之间疾病频率的显著差异，痛风的风险因素在性别之间可能存在很大差异。这项研究将建立在我们以前对男性痛风的研究基础上，全面扩展我们对护士健康研究中女性痛风危险因素的调查。

DESCRIPTION (provided by applicant): Gout is a common and excruciatingly painful inflammatory arthritis associated with hyperuricemia. The condition represents an important type of arthritis that may be substantially controlled through dietary and life-style modifications. Despite the doubling of the incidence of gout among women over the past 20 years and the substantial prevalence particularly in the aging female population, the risk factors for gout among women remain unknown. Recently, we clarified the role of conventionally suspected dietary and other factors on the risk of gout among men in a large prospective study. However, given the important gender differences in uric acid metabolism, the role of sex hormones, and the frequency of gout, the risk factors for gout may vary considerably between sexes. We propose to build upon our previous work on gout among men to comprehensively extend our prospective investigation of risk factors for gout specifically among women in the Nurses' Health Study (n = 121,700). First, we will prospectively investigate the hypothesized relations between conventionally suspected risk factors and the risk of incident gout: 1) increased risk with adiposity, weight gain, intake of meat, seafood, and alcohol [beer and liquor, but not wine], hypertension, and diuretic use; 2) decreased risk with weight loss and dairy intake; and 3) decreased risk with postmenopausal hormone use. Second, we will examine the relations with novel risk factors of gout: 1) increased risk with sugar-sweetened soft drinks and fructose consumption; 2) decreased risk with coffee intake; and 3) decreased risk with vitamin C consumption. During the proposed 2-year study period, we will continue to confirm incident cases of gout according to the American College of Rheumatology (ACR) survey gout criteria. Our primary analysis will involve multivariate modeling to examine independent associations between these potential risk factors and the incidence of gout among women. The significance and strengths of the current proposal include: 1) relevance to the pressing disease burden of a common rheumatic condition (i.e. important prophylactic options for female gout), 2) our experience in gout research, 3) large sample size providing high precision and power for the proposed estimates, 4) prospective incident outcome analysis, and 5) cost-efficient study design using well-established, validated data. This study will provide unique, population-based, prospective data about common modifiable risk factors for gout specifically among women. These aims will fill important gaps in our knowledge of female gout, a common and excruciatingly painful condition with a growing disease burden. PUBLIC HEALTH RELEVANCE: Despite a doubling of the rate of new gout cases among women over the past 20 years, and its substantial disease burden, particularly in the aging female population, the risk factors for gout among women remain unknown. Because of the role of estrogen on uric acid metabolism and the marked differences in disease frequency between men and women, the risk factors for gout may vary considerably between sexes. This study will build upon our previous work on gout among men to comprehensively extend our investigation of risk factors for gout specifically among women in the Nurses' Health Study.