Does Weight Loss Really Work in Gout? Save

A clinical trial has shown that obese gout patients will benefit from diet and lowered body weight, but weight loss was not associated with beneficial effects on serum urica acid (SUA), fatigue or pain.

Weight loss is commonly recommended as management strategy for gout patients. This trial investigated the effect of an intensive dietary intervention on body weight and gout outcomes in patients with obesity and gout.   

Danish patients were randomized, in non-blinded, parallel-group 16 week trial. The primary outcome was change in body weight and serum urate (SUA), pain and fatigue were secondary outcomes. Gout patients had a SUA of at least 5.0 mg/dL and at least one gout flare in the past year. Participants were allowed to use ULT,  but could not change urate lowering therapy (ULT) during the trial.  Dietary intervention was dietician-supervised, hypocaloric, 800-1000 kcal/day from Cambridge Weight Plan for 8 weeks, followed by an 8-week tapering diet, of 1,200 kcal/day.

A total of 61 gout patients (mean age of 60.3 yrs; mean BMI 35.6) were randomly assigned to intensive diet (n=29) or control diet (n=32). Nearly all (97%) were men.  The mean SUA was 7.7 mg/l and only 38% were on ULT.

After 16 weeks, there was a significant difference in weight loss between groups (-15.4 vs -7.7 kg; difference: -7.7 kg [95%CI -10.7 to -4.7], p<0.001).

Despite these differences, there were no differences in changes in SUA , fatigue, pain or gout flares between groups.

While an intensive dietary intervention was safe and effectively lowered body weight in obese people with gout, this did not directly translate into effects on SUA, fatigue and pain.  Its possible that this trial was underpowered with patients who were too mild (no tender/swollen joints, no tophi) and too stable to allow for the detection of a clinical benefit on gout flares or SUA as a surrogate for gout failure/success.