Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies

Abstract

ObjectivesWeight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout.MethodsWe searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation.ResultsFrom 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from −168 to 30 μmol/L, and 0%–60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose–response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery.ConclusionsThe available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials).Systematic review registrationPROSPERO, CRD42016037937.

Effect of immediate and prolonged GLP‐1 receptor agonist administration on uric acid and kidney clearance: Post‐hoc analyses of four clinical trials

“…Thus, these results do not indicate that lixisenatide affects UE UA . Finally, UA levels were unaffected by either GLP‐1RA in our prolonged intervention studies, despite decreases in body weight, thus potentially improving insulin resistance …”

Population Impact Attributable to Modifiable Risk Factors for Hyperuricemia

“…Obesity increases gout risk by raising the serum urate level, through both decreased renal urate excretion and increased urate production (48)(49)(50)(51)(52)(53). Mendelian randomization studies have shown obesity to be causally associated with serum urate levels in the general population (54,55), and weight loss through bariatric surgery or lifestyle intervention leads to reductions in serum urate levels (56). Prompted by an interest in examining the strong biologic mechanism and plausibility of intake of purine, fructose, and alcohol, previous metabolic loading experiments examining these factors (57)(58)(59)(60)(61)(62)(63)(64)(65) have confirmed their serum urate-raising effects, whereas dairy products were shown to have uratelowering effects in 3 experimental studies, including 2 randomized trials (66)(67)(68).…”

<p>Converging Relationships of Obesity and Hyperuricemia with Special Reference to Metabolic Disorders and Plausible Therapeutic Implications</p>

“…Also, unfavorable effects may occur in the short term. 230 Therefore, HU therapy requires comprehensive concerns far beyond only obesity management. The first concern encompasses lifestyle management, such as diet.…”