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Metabolic Syndrome Identified Among Risk Factors for Early Onset Gout in Men

The incidence of gout, the most common type of inflammatory arthritis in men, has increased globally in recent decades.

Metabolic syndrome (MetS) was associated with gout, particularly in young and non-obese men, according to a study published in Frontiers in Medicine.1 Investigators note that managing MetS in young men may be an important factor in gout prevention.

“Gout is the most common type of inflammatory arthritis in men, and the incidence has increased globally in recent decades,” investigators explained. “Although the incidence and prevalence rates of gout increase with age, the rate in young people is increasing. In South Korea, the prevalence of gout in individuals in their 20s and 30s increased by more than 4-fold in 2015 compared with that in 2002. In addition, the age of onset of gout has decreasing.”

A nationwide, population-based cohort comprised of men aged 20-39 years who participated in a national health examination via the Korean National Health Insurance Service (NHIS) between 2009 and 2012 was used to assess the risk factors of gout and the role that MetS plays in developing gout in young men.

After excluding patients who had a previous gout diagnosis or renal impairment, a total of 3,569,104 patients were ultimately included in the study. Gout was defined by the International Classification of Disease 10th revision (ICD-10) code M10. MetS, a collection of cardiovascular risk factors, includes symptoms such as elevated blood pressure (BP), elevated triglyceride (TG), hyperglycemia, central obesity, and low high-density lipoprotein (HDL) cholesterol. The primary outcome was the occurrence of gout and a Cox proportional hazard model assessed the association between gout and MetS.

The mean age of subjects was 31.5 years and 14.6% had MetS at the time of medical examination. Those with MetS were more likely to be older, had a higher BMI, and were current smokers when compared with those without MetS.

The incidence rate of gout was 3.36 per 1000 person-years (n = 88,058) and the mean follow-up duration was 7.35 ± 1.24 years. Patients with MetS had a 2.4-fold higher risk of developing gout when compared with patients without MetS (adjusted HR [aHR] 2.44, 95% CI 2.41–2.48). Among the factors associated with MetS, elevated TG (aHR 2.29, 95% CI 2.26–2.32) and abdominal obesity (aHR 2.45, 95% CI 2.42–2.49) had the greatest association with gout. Further, as these factors increased, the risk of gout increased as well. Subjects with all 5 MetS components had a 5-fold increase in risk of gout when compared with those who had no MetS components (aHR 5.24, 95% CI 4.97–5.52).

Interestingly, the link between gout and MetS was more noticeable in young men and those classified with low and normal weight, with a risk of gout being 3 times higher in those with a baseline age of 20-29 years (aHR 3.02, 95% CI 2.94–3.11), and 2 times higher in those aged 30–39 years (aHR 2.27, 95% CI 2.23–2.31).

The large number of subjects who had MetS despite being classified as low- and normal-weight strengthened the study. Those who had MetS, regardless of weight, were more likely to be more sedentary and consume more alcohol, which may affect the occurrence of gout. Selection bias may have limited the study as only patients who participated in a health check-up were included in the analysis. Further, incidence of gout may have been overestimated as investigators identified gout solely by the ICD code. Dietary factors and nutrition were not evaluated in the analysis. Lastly, generalizability may be limited as the study only included Korean men.

“High BMI, alcohol drinking, and MetS were associated with an increased risk of gout,” investigators concluded. “Compared with subjects without MetS, subjects with MetS had a 2.4-fold increase in the risk of gout. The greater the number of MetS components, the higher the risk of gout. Future research on the mechanism by which MetS increases the risk of gout is warranted.”

Reference:

Eun Y, Han K, Lee SW, et al. Increased risk of incident gout in young men with metabolic syndrome: A nationwide population-based cohort study of 3.5 million men. Front Med (Lausanne). 2022;9:1010391. Published 2022 Nov 14. doi:10.3389/fmed.2022.1010391