High Waist Circumference, Lipid Levels Predict Poor Gout Outcomes

Till Uhlig, MD

Credit: LinkedIn

Over a 2-year period, patients with gout receiving treatment reported reduced lipid levels and relatively unchanged anthropometric measures. Results revealed predictors of unfavorable gout outcomes were high waist circumference and high lipid levels, according to a study published in Rheumatic and Musculoskeletal Diseases.¹

Previous research has linked gout to lifestyle factors, weight gain, comorbidities, such as dyslipidemia, and anthropometric measures including waist/height ratio (WHR), body mass index (BMI), and waist circumference. Of these factors, BMI may be the best predictor of gout risk in men and waist circumference in women.²

“Some evidence supports weight loss for improved gout outcomes,” wrote Till Uhlig, MD, professor in Rheumatology at University of Oslo, Norway and consultant rheumatologist at Diakonhjemmet Hospital, and colleagues. “Very little research from longitudinal studies examines whether recommendations on lifestyle changes and urate-lowering therapy (ULT) lead to improved gout outcomes, that is, absence of flares and successful achievement of the serum urate (sUA) target.”

In the prospective, observational NOR-Gout (Gout in Norway) study, investigators analyzed how anthropometric measures and lipid levels changed during a 2-year period and if they were predictors of gout outcomes. Patients with elevated sUA and a recent gout flare received an educational consultation on gout and treat-to-target ULT over 1 year. BMI, WHR, waist circumference, and lipid levels were collected annually over 2 years to determine their impact on flares and achievement of the sUA target. Lifestyle factors, such as smoking, drinking, consumption of sugar-sweetened drinks, and physical activity were collected at baseline.

Eligible patients met American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria for gout and had increased sUA (>360µmol/L) at inclusion. Participants were enrolled during an acute flare post-examination in a rheumatology outpatient clinic. All patients began ULT with either allopurinol or febuxostat with a treat-to-target goal of achieving sUA <360µmol/L (or <300µmol/L if clinical tophi were present).

A total of 211 patients were included in the study, with a mean age of 56.4 years, mean disease duration of approximately 8 years, and 95% were male. Throughout the study, anthropometric measures remained generally unchanged, although cholesterol and low-density lipoprotein cholesterol (LDL-C) were reduced at the 1-year mark.

Waist circumference and high lipid levels were associated with poor disease outcomes, including gout flares and failure to achieve treatment target. A higher baseline waist circumference decreased the odds of achieving sUA target at year 2 (odds ratio [OR]: .96 per cm, 95% confidence interval [CI]: .93 – .99), while high levels of high-density lipoprotein cholesterol increased these chances (OR: 5.1 per mmol/L, 95%CI: 1.2 – 22.1). Additionally, high LDL-C was proven to predict the chance of gout flare during the second year (OR: 1.8 per mmol/L, 95%CI: 1.2 – 2.6). Factors such as disease duration, older age, creatinine, and lower estimated glomerular filtration rate (eGFR), WHR, and waist circumference were associated with the presence of tophi. Baseline BMI, and WHR were higher in patients who were unable to achieve the sUA outcome at year 2.

Investigators mentioned limitations including the observational nature of the study and the lack of a control population. Additionally, investigators conducted the study in a specialized rheumatology department with intensive ULT, which is not the usual care model for most patients with gout.

“We found that modifiable factors— anthropomorphic and lipid variables—predicted gout outcomes with achieving both the sUA target and flares,” investigators concluded. “Our findings give further support to recommended lifestyle changes in patients with gout, but more research is needed on the role of lipids in gout, and on the best provision of education to these patients.”

References

1. ^{Uhlig T, Karoliussen LF, Sexton J, Kvien TK, Haavardsholm EA, Hammer HB. Lifestyle factors predict gout outcomes: Results from the NOR-Gout longitudinal 2-year treat-to-target study. RMD Open. 2023;9(4):e003600. Published 2023 Dec 1. doi:10.1136/rmdopen-2023-003600}
2. ^{Wändell P, Andreasson A, Hagström H, et al. The use of Anthropometric measures in the prediction of incident gout: results from a Swedish community-based cohort study. Scand J Rheumatol 2019;48:294–9.}