- Design
- Randomised, open-label, active-comparator, 12 weeks
- Population
- 102 men with overweight or obesity and hyperuricaemia
- Primary outcome
- Change in serum urate at week 12
- Effect
- −0.89 (CRD), −0.79 (DASH), −0.50 mg/dL (low-purine); P=0.48 between groups
In a 12-week open-label trial, 102 men with overweight or obesity and hyperuricaemia were randomised to calorie-restricted carbohydrate-restricted, DASH or low-purine diets. Eighty-five completed follow-up.
Weight loss averaged 8.47 kg (9.3%) with no difference between diets. Serum urate fell by 0.89, 0.79 and 0.50 mg/dL respectively, without a significant difference between groups. Capillary urate monitoring showed a transient rise in the first week, coinciding with the peak in gout flares. DASH had the best adherence and less lean mass loss than the carbohydrate-restricted diet.
For the patient with obesity and raised urate, the diet that is easiest to follow is reasonable, and DASH did well on that. The week-one flare window is the clinically useful finding: it is worth warning patients and considering flare cover when a structured weight-loss diet begins.
- Offer the calorie-restricted pattern the patient will stick to; urate fell similarly on all three.
- DASH had the best adherence and preserved more lean mass than carbohydrate restriction.
- Warn patients with gout that flares may increase in the first week of a weight-loss diet.
- Consider flare prophylaxis in established gout when starting structured dieting.
Why it matters
Low-purine advice is often given as the default, but it did no better for urate and was harder to keep.
Don't overread it
A small, men-only, 12-week trial with 17% dropout cannot show that the diets are truly equivalent.
The statistics, in plain English
A between-group P of 0.48 means the differences in urate fall could easily be chance; with 85 completers the trial was too small to rule out a modest real difference.
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