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Clinical and epidemiological research
Extended report
Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies
  1. Sabrina M Nielsen1,
  2. Else M Bartels1,
  3. Marius Henriksen1,2,
  4. Eva E Wæhrens1,3,
  5. Henrik Gudbergsen1,
  6. Henning Bliddal1,
  7. Arne Astrup4,
  8. Filip K Knop5,6,7,
  9. Loreto Carmona8,
  10. William J Taylor9,
  11. Jasvinder A Singh10,
  12. Fernando Perez-Ruiz11,
  13. Lars E Kristensen1,
  14. Robin Christensen1
  1. 1The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
  2. 2Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg, Copenhagen, Denmark
  3. 3The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
  4. 4Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
  5. 5Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
  6. 6Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  7. 7NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  8. 8Institutode Salud Musculoesquelética, Madrid, Spain
  9. 9Department of Medicine, University of Otago, Wellington, New Zealand
  10. 10Department of Medicine, University of Alabama at Birmingham, & Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
  11. 11Rheumatology Division, Hospital de Cruces, Baracaldo, Spain
  1. Correspondence to Robin Christensen, Biostatistician Professor of clinical epidemiology, adj Head of Musculoskeletal Statistics Unit, The Parker Institute,Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57DK-2000 Copenhagen Frederiksberg, Denmark; robin.christensen{at}regionh.dk

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.

  • systematic review
  • hyperuricemia
  • serum uric acid
  • weight reduction

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/annrheumdis-2017-211472

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    Footnotes

    • Contributors Study concept and design: SMN, EMB, LEK and RC. Drafting of the manuscript: SMN, EMB and RC. Search strategy: EMB and SMN. Study selection, data extraction, bias assessment and synthesis: SMN, EMB and RC. Critical revision of the manuscript for important intellectual content and final approval before submission: All authors. Obtained funding: HB, LEK and RC.

    • Funding The Parker Institute, Bispebjerg and Frederiksberg Hospital is supported by a core grant from the Oak Foundation (OCAY-13-309). This research received a specific grant from the will of Mrs Elise Fredriksen; the Oak Foundation had no role in study design or writing of this manuscript.

    • Competing interests This study had no financial competing interests. The Parker Institute is grateful for the financial support received from public and private foundations, companies and private individuals over the years. The Oak Foundation is a group of philanthropic organisations that, since its establishment in 1983, has given grants to not-for-profit organisations around the world.

    • Patient consent No patients were directly included in the study (only in the primary studies of this review).

    • Provenance and peer review Not commissioned; externally peer reviewed.