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The rising incidence of gout has been directly linked to the obesity epidemic. The influence of obesity on gout was further tested in a cohort study of obese patients undergoing bariatric surgery as part of the Swedish Obese Subjects (SOS) study.
This prospective intervention trial compared those receiving bariatric surgery (n= 1982) against obese controls (1999) receiving conventional treatment. None of the subjects had gout at baseline. The median followup for both groups was nearly 19 years.
In the surgery group, 372 subjects underwent gastric banding, 1347 underwent vertical banded gastroplasty and 263 underwent gastric bypass.At the 2-year follow-up, BMI decreased by 23% in the surgery group, but no change in the control group.
Gout occurred more frequently in the control group (201) compared with the surgery group (138). The bariatric surgery had a significantly lower incidence of gout compared with usual care (adjusted HR 0.60, 95% CI 0.48 to 0.75, p<0.001). The number needed to be treated by bariatric surgery to prevent one gout event was 32
Similarly, the bariatric surgery cohort had a lower incidence of hyperuricaemia (adjusted HR 0.47, 95% CI 0.39 to 0.58, p<0.001) and the number of participants needed to be treated by bariatric surgery to prevent hyperuricaemia was 8 (95% CI 6 to 13).
The effect of bariatric surgery on gout incidence was not influenced by baseline risk factors, including body mass index.
The effectiveness of bariatric surgery in preventing gout and hyperuricaemia, underscores the value of weight reduction in gout prevention.