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

Sabrina M Nielsen; Else M Bartels; Marius Henriksen; Eva E Wæhrens; Henrik Gudbergsen; Henning Bliddal; Arne Astrup; Filip Krag Knop; Loreto Carmona; William J Taylor; Jasvinder A Singh; Fernando Perez-Ruiz; Lars Erik Kristensen; Robin Christensen

doi:10.1136/annrheumdis-2017-211472

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

Sabrina M Nielsen, Else M Bartels, Marius Henriksen, Eva E Wæhrens, Henrik Gudbergsen, Henning Bliddal, Arne Astrup, Filip Krag Knop, Loreto Carmona, William J Taylor, Jasvinder A Singh, Fernando Perez-Ruiz, Lars Erik Kristensen, Robin Christensen

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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 â '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.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	76
Issue number	11
Pages (from-to)	1870-1882
Number of pages	13
ISSN	0003-4967
DOIs	https://doi.org/10.1136/annrheumdis-2017-211472
Publication status	Published - 1 Nov 2017

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Journal Article

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Nielsen, S. M., Bartels, E. M., Henriksen, M., Wæhrens, E. E., Gudbergsen, H., Bliddal, H., Astrup, A., Knop, F. K., Carmona, L., Taylor, W. J., Singh, J. A., Perez-Ruiz, F., Kristensen, L. E., & Christensen, R. (2017). Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Annals of the Rheumatic Diseases, 76(11), 1870-1882. https://doi.org/10.1136/annrheumdis-2017-211472

Nielsen, SM, Bartels, EM, Henriksen, M, Wæhrens, EE, Gudbergsen, H, Bliddal, H, Astrup, A, Knop, FK, Carmona, L, Taylor, WJ, Singh, JA, Perez-Ruiz, F, Kristensen, LE & Christensen, R 2017, 'Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies', Annals of the Rheumatic Diseases, vol. 76, no. 11, pp. 1870-1882. https://doi.org/10.1136/annrheumdis-2017-211472

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AU - Nielsen, Sabrina M

AU - Bartels, Else M

AU - Henriksen, Marius

AU - Wæhrens, Eva E

AU - Gudbergsen, Henrik

AU - Bliddal, Henning

AU - Astrup, Arne

AU - Knop, Filip Krag

AU - Carmona, Loreto

AU - Taylor, William J

AU - Singh, Jasvinder A

AU - Perez-Ruiz, Fernando

AU - Kristensen, Lars Erik

AU - Christensen, Robin

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N2 - 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 â '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.

AB - 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 â '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.

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U2 - 10.1136/annrheumdis-2017-211472

DO - 10.1136/annrheumdis-2017-211472

M3 - Journal article

C2 - 28866649

SN - 0003-4967

VL - 76

SP - 1870

EP - 1882

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 11

ER -

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

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