Sedentary Behavior Linked to Increased Gout Risk Even Without Hyperuricemia

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A study showed sedentary behavior was an independent risk factor for gout, and this association was especially pronounced in participants without hyperuricemia.¹

“When [physical activity] was included in our model, the association between sedentary behavior and gout remained robust, suggesting that the impact of sedentary behavior extends beyond the mere lack of [physical activity,” wrote investigators, led by Hengwei Quin, from the department of sports medicine at Huashan Hospital, Fudan University, in Shanghai, China.

On average, adults in the US spend approximately 6 hours doing sedentary activities, whether sitting, watching TV, or lying down. A study reported that sedentary time had increased from 5.5 hours per day in 2007 to 6.4 hours in 2016.²

However, as extensive research has shown, a sedentary lifestyle impacts health, increasing the risk for type 2 diabetes, heart disease, depression and anxiety, cancer, and deep vein thrombosis. A study examining the association between sedentary behavior and the risk of 45 common non-communicable diseases showed that participants who reported > 6 hours of sedentary time had a greater risk of gout than participants who reported sitting ≤ 2 hours per day.³

Studies have shown sedentary behavior increases the risk of hyperuricemia, but sedentary behavior’s direct connection with gout was not clear. Thus, investigators conducted a cross-sectional study to investigate the relationship between a sedentary lifestyle and gout.¹

The team leveraged data from the National Health and Nutrition Examination Survey database and included 34,526 participants from 2007 – 2018. Covariate data was collected for gender, age, race, education level, income-to-poverty ratio, BMI, diabetes, hypertension, chronic kidney disease, drinking status, smoking status, triglycerides, high-density lipoprotein, low-density lipoprotein, total cholesterol, serum creatinine, serum uric acid, and physical activity. Participants were excluded if they were < 20 years old, had no gout data, and had no sedentary activity data.

The sample had a mean age of 47.46 ± 17.01 years, 51.88% females, and 56.89% non-Hispanic White, followed by non-Hispanic Black, Mexican Americans, other ethnicities, and other Hispanic individuals. In total, 4.78% of participants had gout, 20.28% had hyperuricemia, and 79.72 did not have gout or hyperuricemia. Participants had an average sedentary behavior of 6.19 ± 3.39 hours per day.

Participants with gout vs no gout had many differences. For instance, participants with gout were more likely to be older, male, non-Hispanic White, obese, smokers, with hypertension, diabetes, chronic kidney disease, and hyperuricemia. Participants with gout also had lower levels of LDL, HDL, and total cholesterol, as well as greater levels of triglyceride and blood uric acid levels. These participants had less physical activity and more sedentary behavior per day.

Investigators saw a significant increase in gout prevalence from 2017 – 2018, identifying a reversed L-shaped relationship between sedentary behavior and gout (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00 – 1.06; P = .0198).

The study indicates that the relationship may be mediated by body mass index (BMI), although when BMI was added to the model the association between sedentary behavior and gout lost statistical significance (P = .1037).

“This suggests that BMI acts as an important confounder and highlights metabolic dysregulation as a critical pathway linking sedentary behavior to gout,” investigators wrote.

Investigators noted that the link between sedentary lifestyle and gout could be due to sedentary behavior’s association with metabolic diseases. Long sedentary behavior increases lipid storage and reduces glucose intake, insulin sensitivity, muscle fiber content, and mitochondrial oxidate capacity—all of which could lead to metabolic disturbances, and later, gout.

“These findings reinforce the role of metabolic health as a mediating factor in the sedentary behavior–gout relationship,” investigators wrote.

Investigators observed this same L-shaped relationship between sedentary behavior and gout among individuals without hyperuricemia. Among participants with hyperuricemia, > 12 hours per day of sedentary behavior significantly increased the prevalence of gout.

“Our study validated the link between sedentary behavior and gout using large-scale cross-sectional data, identifying a positive correlation, and highlighting the role of hyperuricemia in this relationship, particularly in individuals with asymptomatic hyperuricemia,” investigators wrote.

References

1. ^{Qin H, Hua Y. Association of sedentary behaviour with gout and the interaction effect of hyperuricemia: a cross-sectional study from 2007 to 2018. BMC Public Health. 2024 Dec 18;24(1):3428. doi: 10.1186/s12889-024-20937-4. PMID: 39695456.}
2. ^{Henson J, De Craemer M, Yates T. Sedentary behaviour and disease risk. BMC Public Health. 2023;23(1):2048.}
3. ^{Cao Z, Xu C, Zhang P, Wang Y. Associations of sedentary time and physical activity with adverse health conditions: outcome-wide analyses using isotemporal substitution model. EClinicalMedicine. 2022;48:101424.}