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Rimonabant improves cholesterol, insulin resistance and markers of non‐alcoholic fatty liver in morbidly obese patients: a retrospective cohort study

To the Editor: Increased coffee consumption has been shown to be inversely associated with the risk of gout both in men (1) and women (2). An inverse association has also been found between decaffeinated-coffee consumption and the incidence of gout (1,2), thus suggesting that non-caffeine components of coffee also contributed to the observed inverse association. We suggest that some of the involved mechanisms might be related to inhibition of iron absorption by poliphenol compounds present in coffee, be it regular coffee or decaffeinated coffee. The main phenolic compound in coffee, chlorogenic acid, is a potent inhibitor of nonheme iron absorption (3,4). In particular, it has been reported (3) that the polyphenolic content typical of a cup of instant coffee reduces iron absorption from a test meal by 60–90%. Among elderly participants in the Framingham Heart Study (4), each 236 ml ⁄ week (1 cup ⁄ week) of coffee consumed was associated with 1% lower serum ferritin. On the other hand, mounting evidence suggests that gout may be considered a disease of iron overload. Uric acid accumulation, as both an antioxidant and an iron chelator (5), has been found in response to iron overload (6,7). In fact, human tophi and the synovial membrane contain iron (8). Furthermore, it has been shown that some portion of the gouty inflammation after urate crystal deposition could result from the incomplete complexation of iron with subsequent catalytic generation of reactive oxygen species (6). Indeed, it was found that iron depletion prevented the relapse of the acute arthritis of primary gout in 58% of gouty patients and markedly reduced its frequency and severity in the remaining 42% (9). Finally, it has been shown that the association of coffee intake with reduced insulin resistance may be partially explained by a decrease in body iron level (10); consequently, also the improved insulin sensitivity mediated by coffee-induced inhibition of iron absorption could influence serum uric acid concentrations thus reducing the risk of gout. Moreover, it is well known that there is a strong positive relationship between serum insulin resistance and hyperuricemia (11), and gout forms part of the core metabolic syndrome (12,13). In this setting, it has also been found that insulin reduces the renal excretion of urate (14). Interestingly, tea intake, which is another rich source of polyphenols, was not associated with a reduced incidence of gout (1,2). However, it has been speculated (2) that tea may contain certain offending factors that counteract the potential protective effect on the risk of gout of other beneficial compounds. Therefore, increased intake of polyphenol compounds present in coffee may maintain a relatively low iron status which in turn may reduce the risk of gout.