title: The serum urate-lowering impact of weight loss among men with a high cardiovascular risk profile: the Multiple Risk Factor Intervention Trial.
abstract: OBJECTIVE
  To evaluate the person-level impact of weight loss on serum urate levels among men with a high cardiovascular risk profile.
  
  
  METHODS
  We analysed 12,379 men (mean serum urate level=407 μmol/l) from the Multiple Risk Factor Intervention Trial, using data prospectively collected at baseline and annually over a 7-year period (78,881 visits). Our endpoint was normouricaemia, defined by serum urate levels≤360 μmol/l, a widely accepted therapeutic target. Person-level effects were estimated using conditional logistic regression models to adjust for time-varying covariates (age, congestive heart failure, hypertension, diuretic use, renal function, alcohol intake and dietary factors).
  
  
  RESULTS
  There was a graded relation between weight loss and achieving normouricaemia (P-value for trend<0.001). Compared with no weight change (-0.9 to 0.9 kg), the multivariate odds ratios of achieving normouricaemia for a weight loss of 1-4.9, 5-9.9 and ≥10 kg were 1.43 (95% CI: 1.33, 1.54), 2.17 (1.95, 2.40) and 3.90 (3.31, 4.61), respectively. The corresponding serum urate level changes were -7, -19 and -37 μmol/l (-0.12, -0.31 and -0.62 mg/dl). Similar levels of associations persisted among subgroups stratified by demographics, presence of gout, hypertension, diuretic use, renal insufficiency, alcohol intake, trial group assignment and adiposity categories (all P-values for trend<0.001).
  
  
  CONCLUSIONS
  Weight reduction could help achieve a widely accepted therapeutic urate target level (≤360 μmol/l) among men with a high cardiovascular risk profile. Although the urate-lowering effect appeared weaker than that of urate-lowering drugs, other associated health benefits would make weight reduction important, particularly in this population.
authors.affiliation: Section of Rheumatology and the Clinical Epidemiology Unit, Department of Medicine, Boston University School of Medicine, 650 Albany Street Suite 200, Boston, MA 02118, USA.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Zhu
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
mesh_terms: D001835:Body Weight; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006073:Gout / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood* / Q000378:metabolism; D015431:Weight Loss / Q000502:physiology*
chemical_list: D014527:Uric Acid
references.citation: Am J Med. 1987 Mar;82(3):421-6
references.pmid: 3826098
references.citation: Am J Hypertens. 1996 Aug;9(8):746-52
references.pmid: 8862220
references.citation: Arthritis Rheum. 2008 Jan 15;59(1):109-16
references.pmid: 18163396
references.citation: Int J Obes. 1986;10(4):255-64
references.pmid: 3771090
references.citation: Rheumatology (Oxford). 2008 Oct;47(10):1567-70
references.pmid: 18710901
references.citation: Arthritis Res Ther. 2008;10(5):R116
references.pmid: 18822120
references.citation: J Rheumatol. 2002 Jul;29(7):1350-5
references.pmid: 12136887
references.citation: Ann Intern Med. 2005 Mar 1;142(5):313-22
references.pmid: 15738450
references.citation: Jpn Heart J. 2003 Jul;44(4):527-36
references.pmid: 12906034
references.citation: Prev Med. 1981 Jul;10(4):402-25
references.pmid: 7027236
references.citation: Control Clin Trials. 1987 Dec;8(4 Suppl):41S-53S
references.pmid: 3440389
references.citation: N Engl J Med. 2005 Dec 8;353(23):2450-61
references.pmid: 16339094
references.citation: Ann Epidemiol. 1998 May;8(4):250-61
references.pmid: 9590604
references.citation: Aust N Z J Med. 1973 Aug;3(4):410-2
references.pmid: 4519128
references.citation: Am J Med. 2005 Aug;118(8):816-26
references.pmid: 16084170
references.citation: JAMA. 1991 Dec 4;266(21):3008-11
references.pmid: 1820474
references.citation: Ann Rheum Dis. 2006 Oct;65(10):1312-24
references.pmid: 16707532
references.citation: Arch Intern Med. 1997 Jul 14;157(13):1436-40
references.pmid: 9224221
references.citation: Am J Physiol. 1996 Aug;271(2 Pt 2):F347-55
references.pmid: 8770166
references.citation: JAMA. 2002 Oct 9;288(14):1723-7
references.pmid: 12365955
references.citation: Am J Med. 1974 Nov;57(5):741-6
references.pmid: 4440698
references.citation: Metabolism. 1997 Oct;46(10):1162-5
references.pmid: 9322800
references.citation: J Am Soc Nephrol. 1995 Nov;6(5):1491-7
references.pmid: 8589328
references.citation: Ann Intern Med. 1999 Mar 16;130(6):461-70
references.pmid: 10075613
references.citation: JAMA. 1991 Dec 4;266(21):3004-7
references.pmid: 1820473
references.citation: Hypertension. 2007 Feb;49(2):298-303
references.pmid: 17190877
references.citation: Nature. 2002 May 23;417(6887):447-52
references.pmid: 12024214
references.citation: Arthritis Rheum. 2007 Oct 15;57(7):1324-8
references.pmid: 17907217
references.citation: Arch Intern Med. 2005 Apr 11;165(7):742-8
references.pmid: 15824292
references.citation: Ann Rheum Dis. 2000 Jul;59(7):539-43
references.pmid: 10873964
references.citation: Clin Sci (Lond). 1997 Jan;92(1):51-8
references.pmid: 9038591
references.citation: N Engl J Med. 2004 Dec 23;351(26):2683-93
references.pmid: 15616203
references.citation: Ann Rheum Dis. 1998 Sep;57(9):509-10
references.pmid: 9849306
references.citation: Am J Cardiol. 1986 Jul 1;58(1):1-13
references.pmid: 2873741
references.citation: N Engl J Med. 1996 Feb 15;334(7):445-51
references.pmid: 8552148
references.citation: Rheum Dis Clin North Am. 1990 Aug;16(3):539-50
references.pmid: 2217957
references.citation: Lancet. 1999 Aug 21;354(9179):650
references.pmid: 10466673
references.citation: Am J Epidemiol. 1998 Apr 1;147(7):694-703
references.pmid: 9554609
references.citation: Circulation. 1996 Nov 15;94(10):2417-23
references.pmid: 8921782
references.citation: Ann Intern Med. 2004 Jul 20;141(2):95-101
references.pmid: 15262664
references.citation: Arch Intern Med. 2009 Feb 23;169(4):342-50
references.pmid: 19237717
references.citation: Ann Intern Med. 2005 Oct 4;143(7):499-516
references.pmid: 16204163
references.citation: Adv Exp Med Biol. 1977;76B:231-7
references.pmid: 855748
references.citation: Atherosclerosis. 2001 Apr;155(2):283-90
references.pmid: 11254897
references.citation: J Clin Epidemiol. 1988;41(3):237-42
references.pmid: 3339376
references.citation: Arthritis Rheum. 2008 Jan;58(1):26-35
references.pmid: 18163497
references.citation: Am J Physiol. 1993 Oct;265(4 Pt 2):F504-10
references.pmid: 8238379
references.citation: JAMA. 1982 Sep 24;248(12):1465-77
references.pmid: 7050440
references.citation: Arthritis Rheum. 1983 Jan;26(1):87-93
references.pmid: 6824508
references.citation: Am J Clin Nutr. 1997 Jan;65(1 Suppl):196S-210S
references.pmid: 8988938
references.citation: Metabolism. 1999 Jun;48(6):677-80
references.pmid: 10381138
references.citation: Am J Med. 2007 May;120(5):442-7
references.pmid: 17466656
references.citation: JAMA. 2000 May 10;283(18):2404-10
references.pmid: 10815083