Central Obesity Potentially Linked to Hyperuricemia, Gout

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Higher levels of body mass index (BMI), weight-adjusted waist index (WWI), and body roundness index (BRI) were significantly associated with a dose-dependent, gradual increase in urate levels, although WWI and BRI were superior to BMI in identifying the prevalence of urate levels, hyperuricemia and gout, according to a study published in

Diabetology and Metabolic Syndrome.¹ Despite the lack of a clear causal relationship, investigators encourage clinicians to recognize the impact of obesity on uric acid levels.

Previous research has proven the link between obesity and an increased risk in developing gout and hyperuricemia, with weight identified as a determinant of serum urate levels. Additionally, abdominal obesity is more prevalent among patients with gout compared with those without.²

“It is crucial to comprehend the risk factors contributing to the development of gout and hyperuricemia in order to prevent and reduce costs associated with these conditions,” wrote the team of Chinese investigators.

To determine how measurements of obesity influence gout and urate levels, as well as compare the obesity indicators, investigators used data from the 2001—2018 National Health and Nutrition Examination Survey (NHANES). Smoothed curve fitting was used to evaluate whether there was a nonlinear relationship between WWI, BRI, and BMI indices and gout, hyperuricemia, and urate levels. Diagnostic efficacy of BMI, WWI, and BRI on the prevalence of gout and hyperuricemia were assessed using ROC curves.

A total of 29,310 adult patients aged >20 years were ultimately included in the assessment, of which 14,268 were male. The sample included 5882 patients with hyperuricemia and 1324 patients with self-reported gout. Patients with the highest urate quartiles were more likely be older and have higher levels of cholesterol, fasting glucose, triglycerides, and BMI, BRI, and WWI. They were also more likely to have coronary heart disease, kidney stones, diabetes, and hypertension, and use alcohol and tobacco.

After adjusting for confounders, data revealed higher levels of BMI, WWI, and BRI were linked with a gradual and dose-dependent increase in urate levels.

The sensitivity analysis demonstrated each unit increment in these obesity indicators increased the risk of hyperuricemia and gout. For BMI, WWI, and BRI, the risk of hyperuricemia was 8%, 72%, and 26%, respectively, for each unit. The risk of gout was increased by 5%, 31%, and 15% in BMI, WWI, and BRI, respectively.

The dose-response curves showed a linear positive correlation between BRI, BMI, and WWI, and urate levels, in addition to the prevalence of hyperuricemia and gout. The overall diagnostic efficacy of BRI was superior to BMI in terms of hyperuricemia and gout.

Investigators noted the large sample size and strict adherence to the NHANES study protocol as strengths of the study. However, the cross-sectional study design limited the analysis to the link between the 3 obesity indices and the prevalence of gout, hyperuricemia, and elevated urate. Additionally, they were unable to obtain data on medication use, including those with a potential urate-raising or -lowering effect, reducing the reliability of the findings. Finally, there is a possibility of recall bias as gout assessment relied on completing a questionnaire.

“Managing obesity, as evaluated through obesity indices, could have positive implications for overall physical health,” investigators concluded. “Additionally, the findings suggest that central obesity, which encompasses more than just pure obesity, may provide valuable insights for the management of urate and gout. However, it is important to note that further studies are required to validate and confirm our findings.”

References

1. ^{Mao T, He Q, Yang J, Jia L, Xu G. Relationship between gout, hyperuricemia, and obesity-does central obesity play a significant role?-a study based on the NHANES database. Diabetol Metab Syndr. 2024;16(1):24. Published 2024 Jan 22. doi:10.1186/s13098-024-01268-1}
2. ^{Choi HK, Atkinson K, Karlson EW, Curhan G. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med. 2005;165(7):742–8.}