TY - JOUR
T1 - Effects of low-fat, mediterranean, or low-carbohydrate weight loss diets on serum urate and cardiometabolic risk factors
T2 - A secondary analysis of the dietary intervention randomized controlled trial (direct)
AU - Yokose, Chio
AU - McCormick, Natalie
AU - Rai, Sharan K.
AU - Lu, Na
AU - Curhan, Gary
AU - Schwarzfuchs, Dan
AU - Shai, Iris
AU - Choi, Hyon K.
N1 - Funding Information:
This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50-AR-060772 and R01-AR-065944). C.Y. is supported by the National Institutes of Health Ruth L. Kirschstein Institutional National Research Service Award (T32-AR-007258) and the Rheumatology Research Foundation Scientist Development Award. N.M. is supported by a Canadian Institutes of Health Research Fellowship Award. S.K.R. is supported by a Canadian Institutes of Health Research Doctoral Foreign Study Award. G.C. is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K24-DK-091417). I.S. is supported by Deutsche Forschungsgemeinschaft (SFB 1052) and the Israeli Science Foundation and Israel Ministry of Science and Technology.
Funding Information:
Acknowledgments. The authors thank the DIRECT participants for their consistent cooperation. Funding. This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50-AR-060772 and R01-AR-065944). C.Y. is supported by the National Institutes of Health Ruth L. Kirschstein Institutional National Research Service Award (T32-AR-007258) and the Rheumatology Research Foundation Scientist Development Award. N.M. is supported by a Canadian Institutes of Health Research Fellowship Award. S.K.R. is supported by a Canadian Institutes of Health Research Doctoral Foreign Study Award. G.C. is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K24-DK-091417). I.S. is supported by Deutsche Forschungsgemeinschaft (SFB 1052) and the Israeli Science Foundation and Israel Ministry of Science and Technology. Duality of Interest. G.C. reports research support from Decibel Therapeutics and consulting fees from AstraZeneca, Allena Pharmaceuticals, Shire/Takeda, Dicerna, and Orfan and is the chief medicalofficer at OM1, Inc. H.K.C. reports research supportfromIronwoodandHorizonandconsulting fees from Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart. No other potential conflicts of interest relevant to this article were reported. Author Contributions. C.Y. was involved in the analysis and interpretation of the data and drafted the manuscript. N.M., S.K.R., N.L., G.C., and H.K.C. were involved in the analysis and interpretation of the data and revised the manuscript critically for important intellectual content. D.S. and I.S. were involved in the study design and acquisition, analysis,andinterpretationofthedataandrevised the manuscript critically for important intellectual content. All authors approved the final version of the manuscript to be submitted for publication. H.K.C. is the guarantor of this work and, as such, had access to all the data in study and takes responsibility for integrity of the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented as a podium presentation at the American College of Rheumatology 2019 Annual Meeting, Atlanta, GA, 8–13 November 2019.
Publisher Copyright:
© 2020 by the American Diabetes Association.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85093869770&partnerID=8YFLogxK
U2 - 10.2337/dc20-1002
DO - 10.2337/dc20-1002
M3 - Article
C2 - 33082244
AN - SCOPUS:85093869770
SN - 1935-5548
VL - 43
SP - 2812
EP - 2820
JO - Diabetes Care
JF - Diabetes Care
IS - 11
ER -
