Association between dietary index for gut microbiota and all-cause and cardiovascular disease mortality in patients with gout and hyperuricemia: A prospective cohort study.

ObjectiveGout and hyperuricemia (HUA) are common metabolic disorders associated with increased all-cause and cardiovascular disease (CVD) mortality, and gut microbiota-modulating diets may influence prognosis. We aimed to evaluate whether the Dietary Index for Gut Microbiota (DI-GM) is associated with all-cause and CVD mortality among adults with gout or HUA.MethodsIn this prospective cohort study, we analyzed data from 5,325 adults with gout or hyperuricemia enrolled in the 2007-2018 National Health and Nutrition Examination Survey (NHANES). DI-GM scores were calculated using 24-hour dietary recall data, incorporating 14 predefined food components (10 beneficial and 4 harmful to gut microbiota). Mortality status was ascertained through linkage to the National Death Index up to December 31, 2019. Cox proportional hazards models were applied to estimate hazard ratios and 95% confidence intervals, adjusting for demographic, lifestyle, and clinical factors. Sensitivity analyses, interaction tests, and stratified analyses were conducted to assess robustness.ResultsDuring a median follow-up of 6.5 years (35,625 person-years), 603 deaths occurred, including 197 from CVD. Higher DI-GM scores were associated with significantly lower mortality risk. Participants with DI-GM scores ≥6 had a 33% reduced risk of all-cause mortality and a 45% reduced risk of CVD mortality compared to those with scores ≤ 4. Each one-point increase in DI-GM score was associated with an 8% decrease in all-cause mortality and a 13% decrease in CVD mortality. Results were consistent across all sensitivity analyses.ConclusionsIn individuals with gout or hyperuricemia, higher DI-GM scores were independently associated with reduced all-cause and CVD mortality. These findings suggest that gut microbiota-friendly dietary patterns may provide prognostic value and offer a potential target for dietary interventions in this high-risk population.