Dietary patterns and odds of prevalent gout comorbidity in diabetes mellitus: a mediation analysis of glucose metabolism and renal function

Background: While independent associations between dietary patterns and diabetes mellitus (DM) or gout have been established, their relationship in comorbid conditions remains unclear. We aimed to examine the associations between distinct dietary patterns and prevalent gout among individuals with DM. Methods: We retrieved data in this cross-sectional study from the National Health and Nutrition Examination Survey. We used logistic regression models and Restricted cubic splines to explore associations between five dietary patterns (healthy eating index 2020 (HEI-2020), dietary approaches to stop hypertension (DASH), alternate Mediterranean diet score (aMED), dietary inflammatory index, and alternative healthy diet index). We also conducted subgroup and mediation analyses. Results: In multivariable-adjusted models, HEI-2020 (odds ratio (OR) = 0.82; 95% confidence interval (CI) = 0.70-0.96, P = 0.015), DASH (OR = 0.83; 95% CI = 0.70-0.98, P = 0.031), and aMED (OR = 0.86; 95% CI = 0.74-0.99, P = 0.041) scores were significantly associated with lower odds of prevalent gout among individuals with DM, with no nonlinear trends observed. Subgroup analyses revealed no significant interactions. Mediation analyses suggested that the triglyceride-glucose index-ratio of waist circumference to height mediated 40.2% and 22.8% of the effects of the DASH and HEI-2020 patterns, respectively. Serum uric acid showed evidence of mediation for the aMED pattern accounting for 16.3% of the association. Conclusions: Among people with DM in the USA, adherence to HEI-2020, DASH, and aMED dietary patterns is associated with lower odds of prevalent gout comorbidity in people with DM. Dietary structure improvement may therefore be associated with a lower burden of gout comorbidity in this population.