Effects of low-fat, mediterranean, or low-carbohydrate weight loss diets on serum urate and cardiometabolic risk factors: A secondary analysis of the dietary intervention randomized controlled trial (direct)

Chio Yokose, Natalie McCormick, Sharan K. Rai, Na Lu, Gary Curhan, Dan Schwarzfuchs, Iris Shai, Hyon K. Choi

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

OBJECTIVE Weight loss diets may reduce serum urate (SU) by lowering insulin resistance while providing cardiometabolic benefits, something urate-lowering drugs have not shown in trials. We aimed to examine the effects of weight loss diets on SU and cardiometabolic risk factors. RESEARCH DESIGN AND METHODS This secondary study of the Dietary Intervention Randomized Controlled Trial (DIRECT) used stored samples from 235 participants with moderate obesity ran-domly assigned to low-fat, restricted-calorie (n = 85); Mediterranean, restricted-calorie (n = 76); or low-carbohydrate, non–restricted-calorie (n = 74) diets. We examined SU changes at 6 and 24 months overall and among those with hyper-uricemia (SU ≥416 mmol/L), a relevant subgroup at risk for gout. RESULTS Among all participants, average SU decreases were 48 mmol/L at 6 months and 18 mmol/L at 24 months, with no differences between diets (P > 0.05). Body weight, HDL cholesterol (HDL-C), total cholesterol:HDL-C ratio, triglycerides, and insulin concentrations also improved in all three groups (P < 0.05 at 6 months). Adjusting for covariates, changes in weight and fasting plasma insulin concentrations remained associated with SU changes (P < 0.05). SU reductions among those with hyper-uricemia were 113, 119, and 143 mmol/L at 6 months for low-fat, Mediterranean, and low-carbohydrate diets (all P for within-group comparison < 0.001; P > 0.05 for between-group comparisons) and 65, 77, and 83 mmol/L, respectively, at 24 months (all P for within-group comparison < 0.01; P > 0.05 for between-group comparisons). CONCLUSIONS Nonpurine-focused weight loss diets may simultaneously improve SU and cardiovascular risk factors likely mediated by reducing adiposity and insulin resistance. These dietary options could provide personalized pathways to suit patient comorbidity and preferences for adherence.

Original languageEnglish
Pages (from-to)2812-2820
Number of pages9
JournalDiabetes Care
Volume43
Issue number11
DOIs
StatePublished - 1 Nov 2020

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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