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
- serum uric acid
- weight reduction
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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.
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