Greater adiposity and weight gain are strong risk factors for gout in men, while weight loss is protective, according to the largest study to date of verified gout cases.
Investigators for the Health Professionals Follow-Up Study prospectively analyzed body mass index (BMI) measured at age 21 years, baseline, and updated every 2 years in a population of mostly (91%) white men with no previous history of gout. The participants were aged 40 through 75 years at baseline in 1986.
During the 12-year follow-up, there were 730 confirmed incident cases of gout in 47,150 men (Arch. Intern. Med. 2005;165:742–8).
Weight gain since young adulthood was strongly associated with the risk of gout, even after adjustment for initial weight and other risk factors, according to lead author Hyon K. Choi, M.D., Massachusetts General Hospital, Boston.
The relative risk of gout for men who had gained 30 pounds or more since age 21 was 2.47 compared with men who maintained their weight.
The relative risk of gout was 1.57 for those men who gained 20–29 pounds.
Weight gain since baseline and increasing waist-to-hip ratio also were significantly associated with increased risk of gout.
After adjustment for age, the relative risk of developing gout among men in the highest waist-to-hip ratio quintile (0.98–1.39) compared with those in the lowest quintile (0.70–0.88) was 2.39.
In contrast, men who had lost 10 pounds or more since the study's baseline had a 39% lower risk of gout compared with men who had maintained weight.
“To our knowledge, our study is the first to document this important potential benefit of weight loss,” Dr. Choi wrote.
The investigators also found that the presence of hypertension was strongly associated with the incidence of gout, independent of diuretic use and chronic renal failure.
The relative risks of gout were 2.31 for the presence of hypertension and 1.77 for diuretic use.
“Since more than half of the gout cases in our cohort occurred among those with hypertension, the potential impact of the prevention of hypertension on the incidence of gout is substantial,” he wrote.