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) (original) (raw)
Cardiovascular and Metabolic Risk| September 02 2020
1Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
2Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA
3Department of Medicine, Harvard Medical School, Boston, MA
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1Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
2Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA
3Department of Medicine, Harvard Medical School, Boston, MA
4Arthritis Research Canada, Richmond, British Columbia, Canada
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4Arthritis Research Canada, Richmond, British Columbia, Canada
5Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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4Arthritis Research Canada, Richmond, British Columbia, Canada
6Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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6Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
7Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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8Department of Emergency Medicine, Soroka University Medical Center, and Faculty of Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
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;
9S. Daniel Abraham Center for Health and Nutrition, Ben-Gurion University of the Negev, Beer Sheva, Israel
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1Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA
2Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA
3Department of Medicine, Harvard Medical School, Boston, MA
4Arthritis Research Canada, Richmond, British Columbia, Canada
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Diabetes Care 2020;43(11):2812–2820
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 randomly 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 hyperuricemia (SU ≥416 μmol/L), a relevant subgroup at risk for gout.
RESULTS
Among all participants, average SU decreases were 48 μmol/L at 6 months and 18 μmol/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 hyperuricemia were 113, 119, and 143 μmol/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 μmol/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.
N.M. and S.K.R. contributed equally to this work.
© 2020 by the American Diabetes Association
2020
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