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Ann Rheum Dis. 2017 Nov;76(11):1870-1882. doi: 10.1136/annrheumdis-2017-211472. Epub 2017 Sep 2.

Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies.

Author information

1
The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
2
Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
3
The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
4
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
5
Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
6
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
7
NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
8
Institutode Salud Musculoesquelética, Madrid, Spain.
9
Department of Medicine, University of Otago, Wellington, New Zealand.
10
Department of Medicine, University of Alabama at Birmingham, & Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA.
11
Rheumatology Division, Hospital de Cruces, Baracaldo, Spain.

Abstract

OBJECTIVES:

Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout.

METHODS:

We searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation.

RESULTS:

From 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from -168 to 30 μmol/L, and 0%-60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose-response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery.

CONCLUSIONS:

The available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials).

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42016037937.

KEYWORDS:

hyperuricemia; serum uric acid; systematic review; weight reduction

PMID:
28866649
PMCID:
PMC5705854
DOI:
10.1136/annrheumdis-2017-211472
[Indexed for MEDLINE]
Free PMC Article

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