Weight-loss diets lower gout risk, improve cardiovascular risk profile

Several weight-loss diets can simultaneously reduce serum urate (SU) concentrations and cardiovascular risk factors, effects that are mediated by excess pounds shed and improved insulin levels, as shown in a study.

Researchers conducted a secondary analysis of the Dietary Intervention Randomized Controlled Trial (DIRECT), which involved 235 participants with moderate obesity randomized to one of the following dietary interventions: low-fat, restricted-calorie (n=85); Mediterranean, restricted-calorie (n=76); or low-carbohydrate, nonrestricted-calorie (n=74) diets.

The participants were 52 years on average, with a mean body mass index of 30.5 kg/m². Most of them were men (88 percent). The mean SU concentration at baseline was 363 µmol/L, and 24 percent of participants had levels of ≥416 µmol/L. In terms of comorbidities, 59 percent had hypertension, 15 percent had diabetes, and 36 percent had coronary heart disease.

All three diet groups showed reductions in SU levels averaging 48 μmol/L at 6 months and 18 μmol/L at 24 months, with no between-group differences (p>0.05). There also were notable improvements in body weight, high-density lipoprotein cholesterol (HDL-C), total cholesterol:HDL-C ratio, triglycerides, and insulin concentrations (p<0.05 at 6 months in all groups).

Changes in weight and fasting plasma insulin concentrations strongly correlated with that of SU (p<0.05).

In the subgroup of participants with hyperuricaemia, a greater magnitude of decrease in SU concentrations was seen across all groups with no significant difference between them: 113 μmol/L with low-fat, 119 μmol/L with Mediterranean, and 143 μmol/L low-carbohydrate diets at 6 months (within-group comparison, p<0.001 for all; between-group comparisons, p>0.05). The corresponding reductions at 12 months were 65, 77, and 83 μmol/L (within-group comparison, p<0.01 for all; between-group comparisons, p>0.05).

The findings suggest a beneficial role for the tested dietary interventions in improving both cardiovascular risk factors and SU control in patients with hyperuricaemia, the researchers said. Furthermore, the consistent benefits seen across all three diets mean that patients can choose the diet that best suits them in terms of comorbidity and for adherence.