Background: While specific alcoholic beverages have been associated with gout, the influence of residual confounding and potential reverse-causation bias on these associations remains to be addressed. Methods: The exploratory analysis included 218,740 men and 271,389 women free of gout at recruitment of the UK Biobank. Among these, 181,925 men and 223,700 women remained for the final analysis where potential reverse causation was addressed, i.e., by excluding participants who had or were likely to have reduced alcohol intake due to health issues at baseline, in addition to cases that were identified within the first 2 years of follow-up. Results: In the final analysis, current drinkers had a higher risk of gout than never drinkers in men (HR = 1.78, 95% CI: 1.39-2.28) but not in women (HR = 0.84, 95% CI: 0.68-1.03). Among current drinkers, higher alcohol consumption was associated a substantially higher risk of gout in men and a moderately higher risk in women. The most evident sex difference in the consumption of specific alcoholic beverages was observed for beer/cider (mean: 4.16 vs. 0.44 pints/week in men and women, respectively). Consumption of champagne/white wine, beer/cider, and spirits each was associated with a higher risk of gout in both sexes, with beer/cider showing the strongest association (HR per 1 pint/d = 1.55, 95% CI: 1.49-1.61 in men; HR per 1 pint/d = 1.71, 95% CI: 1.14-2.57 in women). In the exploratory analysis, low to moderate consumption of specific alcoholic beverages were widely associated with a lower risk of gout, whereas all these inverse associations were eliminated in the final analysis. For example, red wine intake was associated with a lower risk of gout in women in the exploratory analysis (HR per 1 glass/d = 0.79, 95% CI: 0.69-0.90), but not after adjusting for other alcoholic beverages and addressing potential reverse causation (HR per 1 glass/d = 0.91, 95% CI: 0.77-1.06). Conclusions: Consumption of total and several specific alcoholic beverages is associated with a higher risk of gout in both sexes. The sex-specific associations for total alcohol consumption may be attributable to differences in the type of alcohol consumed rather than biological differences between men and women.

The authors have declared no competing interest.

This work is supported by the Gusu Leading Talent Plan for Scientific and Technological Innovation and Entrepreneurship (ZXL2023345).

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