Incident gout and weight change patterns: a retrospective cohort study of US adults

Abstract

Background: Although the relationship between obesity and incident gout has been clarified, the influence of weight changes during the transition from early adulthood to midlife and the different weight change patterns in specific age ranges on the incidence of gout in later life remain unknown. Therefore, we aimed to investigate the association between weight change patterns across adulthood and incident gout.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), we categorized individuals into four weight change patterns: those who remained obese (stable obese), those who moved from a non-obese body mass index (BMI) to an obese BMI (gaining), those who moved from an obese BMI to a non-obese BMI (losing), and those who remained non-obese (stable non-obese). Incident gout reflected its occurrence over the 10-year follow-up from the recalled midlife weight measure to the time of this survey. Hazard ratios (HRs) and 95% confidence intervals relating weight change patterns to incident gout over the 10-year follow-up period were calculated using Cox models adjusted for covariates. The hypothetical population attributable fraction (PAF) for the weight change patterns was calculated.

Results: Among our sample of adults aged 40-74 years at their midlife weight measure (n = 11,079), 320 developed gout. The highest risk of incident gout was found for participants with the stable obese pattern (HR 1.84; 1.08-3.14) and not for participants who remained stable non-obese during adulthood. Moreover, gaining weight was a significant risk factor for incident gout (HR 1.65; 1.19-2.29). No significant associations were found between losing weight change patterns and the risk of gout during the study period. If participants who gained weight had become non-obese during the 10-year follow-up, an estimated 3.2% (95% CI 0-6.3) of observed gout cases could have been averted. In addition, if the population had maintained a normal BMI, 32.9% (95% CI 18.2-44.9) cases could have been prevented during the 10 years.

Conclusions: Gaining weight over adulthood was associated with an increased risk of gout. These findings have highlighted that maintaining non-obese weight and weight loss across adulthood is essential for the prevention and treatment of gout in adult life.

Keywords: Cohort; Gout; Weight change.

Fig. 1

Study design for analysis of incident gout (n = 11,079). Creation of a cross-sectional, retrospective cohort of US adults. We studied individuals who participated in the NHANES (2007–2014) cross-sectional survey at ages 40–74 years. It was based on the participants’ memory recalled weight history at age 25 (young adulthood) and 10 years before the survey (age 30–64 years, midlife), which was used to create a measure of weight change between young adulthood and midlife. We then investigated the association between this weight change and the successive risk of developing gout. “Follow-up” for incident gout began 10 years before the survey. Individuals who reported receiving a first diagnosis of gout between 10 years before the survey and time of the survey were considered to have incident gout

Fig. 2

Cumulative incident gout of recent 10 years by weight change category from age 25 to 10 years before the survey. (1) Stable non-obese, BMI₂₅ < 30 kg/m² and BMI_{10 prior} < 30 kg/m²; (2) losing, BMI₂₅ ≥ 30 kg/m² and BMI_{10 prior} < 30 kg/m²; (3) gaining, BMI₂₅ < 30 kg/m² and BMI_{10 prior} ≥ 30 kg/m²; and (4) stable obese, BMI₂₅ ≥ 30 kg/m² and BMI_{10 prior} ≥ 30 kg/m²