Addressing Obesity May Reduce Gout Incidence, Prevalence

Natalie McCormick, PhD

Addressing obesity may prevent the majority of incident gout cases among men, according to recent study findings.

The findings suggested men with obesity may not benefit from other lifestyle modifications unless they were focused on weight loss.

Natalie McCormick, PhD, and a team of investigators estimated the proportion of incident gout cases that could be avoided through simultaneous modification of obesity and other key risk factors. They used data collected from men enrolled in the Health Professionals Follow-Up Study—a study of 51,529 male health professionals enrolled in 1986 and followed up through questionnaires every 2 years through 2012. Gout cases were self-reported and confirmed through June 2015.

Male dentists, optometrists, osteopaths, pharmacists, podiatrists, and veterinarians were included in the study. A majority of the men were white (91%) and were aged 40-75 years old at the initiation of the study in 1986. Those included did not have a diagnosis of gout at baseline.

Participants returned a mailed questionnaire assessing their medical history, current diet, and lifestyle habits. The team administered questionnaires every 2 years with a follow-up rate of more than 90%.

McCormick and the investigators calculated body mass index (BMI) using the most recently updated weight of the participants. Dietary intake was assessed using a validated food frequency questionnaire. Further, participants reported information on regular use of medications and other medical conditions.

The team focused on 4 common modifiable factors association with gout risk, obesity, alcohol, diet, and diuretic use.

Low-risk groups were defined based on the levels of each risk factor for end points such as myocardial infarction, type 2 diabetes, and hypertension. Adiposity low risk was a BMI less than 25.

Overall, 44,654 men were included in the final analysis and 1741 cases (3.9% of men) of gout were identified over 26 years of follow-up. The most important risk factor was BMI, the team noted, with RRs of 1.29 (95% CI, 1.06-1.57), 1.9 (95% CI; 1.59-2.25), and 2.65 (95% CI, 2.18-3.22) for men with a BMI of 23-24.9 (higher end of normal), 25-29,9 (overweight), and 30 or greater (obesity), respectively.

Among the participants, 31% (95% CI, 26-35) of incident gout cases were attributed to being overweight or obese.

Alcohol intake, a DASH-style diet, and diuretic use were also all individually associated with an increased risk of developing gout. The team found 22% (95% CI, 11-32) of incident gout cases could have theoretically been prevented through adherence to a DASH-style diet.

Those in the 2 low-risk factor category (BMI <25 and no alcohol intake) had an RR for incident gout of .54 (95% CI, .43-.67) compared with all other men in the cohort. The PAR was 43% (95% CI, 32-54), which suggested 43% of incident gout cases may have been prevented if all men had been of normal weight with no alcohol intake. The percentage increased to 69% (95% CI, 47-82) when adherence to a DASH-style diet was added and further increased to 77% (95% CI, 56-88) when no diuretic use was included).

The findings of the study supported the prominent role of such modifiable lifestyle factors in increasing the incidence and prevalence of gout.

The study, “Estimation of Primary Prevention of Gout in Men Through Modification of Obesity and Other Key Lifestyle Factors,” was published online in JAMA Network Open.