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Weight loss, diet and gout

 

Clinical bottom line

Weight reduction associated with a change in macronutrient intake as recommended for insulin resistance reduced serum urate levels, gouty attacks, and dyslipidaemia.


Reference


PH Dessin et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000 59: 539-543.


Methods

In this study 13 white male patients with at least two gouty attacks in the previous four months (and without endocrine disorders) enrolled in a calorie-restricted dietary regimen. After initial screening they had a 1,600 calorie/day diet with 40% of energy from carbohydrate, 30% form protein and 30% from fat in three to five meals a day. Refined carbohydrates were replaced with complex carbohydrates, saturated with monounsaturated fat, and fish was recommended at least four times a week. There was no treatment specifically to lower serum urate levels.

Follow up visits were at 4, 10 and 16 weeks, where weight, diet and gouty attacks evaluated. Alcohol (less than 25 g/day) was allowed.

Results

The men initially were mostly overweight or obese, had a recent attack of gout, and had high serum cholesterol or LDL cholesterol (or both), high serum triglycerides, and high serum urate levels. Improvements in all these were seen at 16 weeks.

Table 1: Initial results and later evaluation

Before diet

After diet

Item

Normal

Normal

Overweight or obese (BMI more than 25)

1/13

2/13

Recent attack of gout

13/13

4/13

High total cholesterol or LDL cholesterol

7/13

1/13

High triglyceride

9/13

3/13

Serum urate above 0.42 mmol/L

12/13

9/13

Men had lost weight by an average of 8 kg over the 16 weeks (from an initial mean of 91 kg). The mean level of serum urate fell from 0.57 mmol/L to 0.47 mmol/L, and the mean number of gouty attacks per month from 2.1 to 0.6. Eleven of the 13 men had a history of more than one gouty attack per month before the dietary intervention. After it, all but one had less than one gouty attack per month.

Comment

This is an open, non-randomised pilot study. It demonstrated the link between dyslipidaemia, obesity predisposing to insulin resistence and eventually to diabetes, and serum urate and gout. None of these men had treatment to reduce their serum urate levels, but weight loss and calorie restriction lowered both lipids and serum urate, despite 30% of calories coming from protein. The reduction in gouty attacks was impressive.