Obesity Indicators Linked to Gout Risk in Patients with Type 2 Diabetes

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A cross-sectional population-based study in China identified a significant and positive link between obesity and gout risk among patients with type 2 diabetes (T2D).¹

These data showed obesity indicators, including body mass index (BMI), waist circumference, waist-to-hip ratio, and visceral fat area, were notably higher in patients with gout, suggesting a potential predictive capability for disease development.

“Obesity and gout risk were found to be significantly and positively linked in patients with T2D,” wrote the investigative team, led by Yiyun Wang, department of internal medicine, Yuhuan Second People’s Hospital. “Uncovering the causality behind the relationship requires further prospective study.”

Evidence has displayed the increasing prevalence of gout globally, with prevalence rates experiencing an increase from 0.08% in 2010 to 2–4% by 2020.² In the case of comorbid T2D, patients with gout can experience worse effects of the disease, lower quality of life, and an increased financial burden, for both the patient and society.

Obesity is another noteworthy global health issue and has been linked to gout risk, potentially via elevated levels of serum uric acid.³ Using various obesity indicators, Wang and colleagues investigated the correlation between generalized, abdominal, and visceral fat obesity on gout prevalence in patients with T2D.¹

The study collected data on 10,848 participants from electronic medical databases in China between September 2017 and June 2023. After screening for T2D diagnosis and age ≥18 years, 10,535 people were enrolled for analysis.

Overall, investigators analyzed 4 obesity indicators, including waist circumference, waist-to-hip ratio, BMI, and visceral fat area. Obesity thresholds used in the analysis were BMI ≥28.0 kg/m2, waist circumference >90 cm for men or >85 cm for women, waist-to-hip ratio >0.90 for men and >0.85 for women, and visceral fat area ≥100 cm2.

Among the enrolled population, including 600 cases and 9,935 controls, the median age was 55 years and 6342 (60.2%) were men. Patients with gout experienced notably larger values of the obesity indicators, compared with those without gout, as well as higher proportions of obesity, hypertension, and hyperlipidemia.

After adjustment for relevant confounding factors, obesity was associated with a higher prevalence of gout, by definitions of BMI (odds ratio [OR], 1.775; 95% CI, 1.468–2.145), waist circumference (OR, 1.691 [95% CI, 1.394–2.053]), waist-to-hip ratio (OR, 1.858; 95% CI, 1.367–2.524), and visceral fat area (OR, 1.578; 95% CI, 1.317–1.890) (all P <.001).

In multivariate regression models, adjusted for confounders, investigators identified a significant increase in the ORs of gout from the lowest to highest quartiles of obesity indicators (P-value for trend <.001). Restricted cubic spline (RCS) analysis also revealed positive correlations between obesity indicators and gout prevalence.

Investigators further analyzed the ability of obesity parameters to diagnose gout using Receiver operative characteristic (ROC) curves. Area under the ROC curve values for BMI, waist circumference, waist-to-hip ratio, and visceral fat area were 0.629, 0.651, 0.634, and 0.633, respectively.

In their summary, Wang and colleagues pointed to the potential predictive ability of obesity indicators to determine the development of gout in patients with T2D.

“Avoiding excessive gain in weight, waist circumference, and visceral fat area may be an effective approach to prevent gout in patients with T2D,” they added.

References

1. _{Cai N, Chen M, Feng P, et al. Relationships between obesity and prevalence of gout in patients with type 2 diabetes mellitus: a cross-sectional population-based study. BMC Endocr Disord. 2024;24(1):137. Published 2024 Aug 2. doi:10.1186/s12902-024-01672-8}
2. _{Guan Y, Wei J, Meng L, et al. Genetically predicted physical activity is associated with lower serum urate concentrations. Genes Genomics. 2022;44(7):843-853. doi:10.1007/s13258-022-01239-8}
3. _{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}