Weight loss lowers urate whichever diet is chosen, but flares peak in week one

Design

12-week open-label, three-arm randomised trial

Population

102 men with overweight or obesity and hyperuricaemia

Primary outcome

Change in serum urate at 12 weeks

Effect

-0.89 (carbohydrate-restricted) vs -0.79 (DASH) vs -0.50 mg/dL (low-purine); P = 0.48

A 12-week open-label randomised trial assigned 102 men with overweight or obesity and hyperuricaemia to one of three calorie-restricted diets, all set at 20 to 25 kcal per kg of ideal body weight: carbohydrate-restricted, DASH, or a low-purine balanced diet.

Average weight loss was 8.5 kg (9.3%), with no difference between diets. Serum urate fell by 0.89 mg/dL with carbohydrate restriction, 0.79 with DASH and 0.50 with the low-purine diet; the difference between diets was not significant. Adherence was best with DASH, which also preserved more lean mass than carbohydrate restriction. Capillary monitoring showed urate rose briefly in the first week, coinciding with a peak in gout flares.

Two practical points follow. The diet a patient can sustain matters more than its purine content, and DASH was easiest to follow. And starting a structured weight-loss diet can provoke early flares, so flare risk needs planning.

The trial was small, short, open-label, in men only, and 17% did not complete follow-up. It does not show effects on long-term gout outcomes.

• Encourage weight loss in men with hyperuricaemia; urate fell on all three diets.
• Let patients choose a diet they can sustain; DASH had the best adherence.
• Do not rely on a low-purine diet alone; it lowered urate least, though differences were not significant.
• Warn patients with gout that flares may rise in the first week of dieting.
• Consider flare prophylaxis or a flare plan when a structured diet begins.

Why it matters

The low-purine diet many patients are given is not clearly better and may be harder to keep.

Don't overread it

A 12-week trial of urate levels in men; it does not show fewer long-term gout attacks.

The statistics, in plain English

Urate falls of 0.5 to 0.9 mg/dL were not significantly different between diets, but with 85 completers the trial could miss a modest difference. A P value of 0.99 for weight loss means the diets performed almost identically on weight.

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