Faster Weight Loss on Anti-Obesity Medication Correlated With Lower Risk of Gout

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Faster weight loss in overweight or obese adults with after initiating orlistat anti-obesity medication was associated with lower rates of incident gout and gout recurrence.¹

“Weight loss is conditionally recommended for gout management; however, its impact on incident gout and recurrent gout flares among overweight and obese individuals remains unknown,” lead investigators Jie Wei, PhD, and Yilun Wang, MD, PhD, Department of Orthopaedics, Xiangya Hospital, Central South University, and Hunan Key Laboratory of Joint Degeneration and Injury, and Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Changsha, China, wrote.¹

Wei and Wang collected data from 131,000 adults in The Health Improvement Network and stratified weight loss into 4 groups within the first year of initiating orlistat: weight gain/stable, slow weight loss (2-5%), moderate weight loss (5-10%), or fast weight loss (at least 10%). Within these groups, they analyzed associations between incident and recurrent gout during 5 years of follow-up.¹

Using data from The Health Improvement Network, we selected individuals aged 18 and older who were overweight or obese and started anti-obesity medication. We emulated a target trial to examine the association of different weight loss rates, slow (2-5%), moderate (5-10%), or fast (≥10%), within the first year of treatment with incident gout and recurrent gout flares during a 5-year follow-up period.¹

The investigators found that the 5-year risk of incident gout was 1.6% in the weight gain/stable group, 1.5% in the slow weight loss group, 1.3% in the moderate weight loss group, and 1.2% in the fast weight loss group. Compared with the weight gain/stable group, the slow weight loss group had a hazard ratio (HR) of incident gout of 0.91 (95% CI, 0.81-1.01), the moderate weight loss group had an HR of 0.82 (95% CI, 0.72-0.92), and the fast weight loss group had an HR of 0.73 (95% CI, 0.62-0.86).¹

Wei, Wang, and colleagues also analyzed the risk of recurrent gout flares in the 3,847 participants that had gout at orlistat initiation. They stated that findings were similar in these participants, with the fast weight loss group having the lowest risk of recurrent gout flares, however, these data were not available.

Other similar research out of Jiaying University in China recently found that found that higher triglyceride glycemic (TyG) index was associated with an increased likelihood of gout in adults in the United States. The investigators conducted a cross-sectional study of 11,768 adults with complete TyG index and gout data from the National Health and Nutrition Examination Survey (NHANES from 2007 to 2017. TyG index was calculated by multiplying fasting triglycerides (mg/dl) by fasting glucose (mg/dl)/2 and gout was assessed by a self-report questionnaire (MCQ160n).²

The study found that, after adjusting for all covariates, TyG index was positively associated with gout, with each unit increase in TyG index associated with 40% higher odds of gout (odds ratio (OR), 1.40 [95% CI, 1.82–2.66]; P <.0001). Accordingly, participants in the highest TyG index tertile group were at high risk of gout (odds ratio (OR), 1.64 [95% CI, 1.06–2.54]; P = .03) compared with those in the lowest tertile group. Investigators found no significant effects of age, race, marital status, PIR level, education, BMI, smoking status, drinking status, hypertension, and diabetes mellitus status on the association between TyG index and gout (all P >.05).²

REFERENCES

1. Wei J, Wang Y, Dalbeth N, et al. Weight loss after initiating anti-obesity medications and gout among overweight and obesity individuals: a population-based cohort study. Arthritis Rheumatol. Published online September 19, 2024. doi.org/10.1002/art.42996

2. Li, T, Zhang, H, Wu, Q, Guo S, Hu W. Association between triglyceride glycemic index and gout in US adults. J Health Popul Nutr. 2024;43 (115). doi: 10.1186/s41043-024-00613-4