Insulin Resistance Associated With Higher Risk of Gout in Adults

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New research has found that higher triglyceride glycemic (TyG) index was associated with an increased likelihood of gout in adults in the United States.¹

“To the best of our knowledge, this is the first study on the association between the TyG index and gout based on the large sample size of the NHANES database. Therefore, this study contributes to the literature. Continuous and categorical variables were employed as various forms of independent variables to construct robust multiple regression models; it adds strong evidence egarding the positive association between the TyG index and gout,” lead investigator Tao Li, Department of Pathophysiology, Medical College, Jiaying University, Meizhou, Guangdong Province, China, and colleagues wrote.¹

The investigators conducted a cross-sectional study of 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). Li and colleagues used weighted chi-squared and weighted Student’s t-test to assess group differences, and used weighted multivariable logistic regression analysis, subgroup analysis, and interaction tests to examine the association between TyG index and gout.¹

There were 11,768 participants included in the analysis. Around half (n = 5910; 50.32%) were women, 7784 (73.26%) were between 18 and 60 years old, 5232 (69.63%) were white, and 573 (5.12%) had gout. Li and colleagues 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).¹

“These results underscore that the treatment and management of IR may prevent or improve the occurrence and development of gout, and the TyG index may be a predictive tool for gout. Further, longitudinal studies are needed to examine the causal association between the TyG index and gout in the broader population to elucidate the potential mechanism of IR on gout,” Li and colleagues concluded.¹

Another recent study on gout found a negative correlation between serum vitamin D and mortality. It also revealed a U-shaped relationship between vitamin D in patients with hyperuricemia (HUA).²

Lead investigator Ke Liu, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, and coauthors found that, after multifactorial adjustment, per one-unit increment in natural log-transformed 25(OH)D was associated with a 55% lower risk in all-cause mortality and a 61% lower risk of CVD mortality in patients with gout (both P ≤.003). In patients with HUA, they found a 45% lower risk of cancer mortality (P = .009). Furthermore, restricted cubic splines revealed a U-shaped relationship with all-cause and CVD mortality in patients with HUA with inflection points of 72.7 nmol/L and 38.0 nmol/L, respectively (both P ≤.003). The data trends were corroborated by subgroup and sensitivity analyses, although not always to statistical significance.²

“Though there are several major advances in gout treatment, including anti-inflammatory drugs, synthetic adrenocorticotropic hormone, oral colchicine, studies have shown that gout patients have a 17% increased risk of mortality than general population, thus determining the controllable causes is vitally important to reduce complications and mortality among patients with gout and hyperuricemia,” Liu and coauthors wrote.²

REFERENCES
1. 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
2. Liu K, Lu X, Wang A, et al. Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with gout and hyperuricemia. Nutr J. (2024);89(23). https://doi.org/10.1186/s12937-024-00992-8