TY - JOUR
T1 - Effects of a behavioral weight loss intervention and metformin treatment on serum urate
T2 - Results from a randomized clinical trial
AU - Hu, Jiun Ruey
AU - Yeh, Hsin Chieh
AU - Mueller, Noel T.
AU - Appel, Lawrence J.
AU - Miller, Edgar R.
AU - Maruthur, Nisa M.
AU - Jerome, Gerald J.
AU - Chang, Alex R.
AU - Gelber, Allan C.
AU - Juraschek, Stephen P.
N1 - Funding Information:
Funding: This work was supported by study funding from the Maryland Department of Health Cigarette Restitution Fund (CRF) and the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center H.-C.Y. was supported by the National Institute of Diabetes and Digestive and Kidney Diseases [grant number P30DK079637] and the National Cancer Institute [grant number 5P30CA006973]. S.P.J. was supported by the National Institute of Diabetes and Digestive and Kidney Diseases [grant number T32DK007732-20] and the National Heart, Lung, and Blood Institute [grant number K23HL13527301]. NTM was supported by the National Heart, Lung, and Blood Institute [grant number 1K01HL141589-01]. J.-R.H. was supported by the Linda Kao Memorial Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/8
Y1 - 2021/8
N2 - Background: Lower body mass index (BMI) has been associated with lower serum urate (SU), but only in observational studies. We sought to determine the effects of behavioral weight loss and metformin treatment on SU in a randomized trial. Methods and Findings: The Survivorship Promotion In Reducing IGF-1 Trial (SPIRIT) was a parallel three-arm randomized controlled trial of overweight/obese adult cancer survivors without gout at a single center in Maryland, United States. Participants were randomized to: (1) coach-directed weight loss (behavioral telephonic coaching), (2) metformin (up to 2000 mg daily), or (3) self-directed weight loss (informational brochures; reference group). SU and BMI were assessed at baseline and at 3, 6, and 12 months post-randomization. The 121 participants had a mean ± standard deviation (SD) age of 60 ± 9 years, 79% were female, and 45% were Black. At baseline, BMI was 35 ± 5 kg/m2, and SU was 5.6 ± 1.3 mg/dL. Compared to the self-directed group, at 12 months, the coach-directed group reduced BMI by 0.9 kg/m2 (95% confidence interval (CI): −1.5, −0.4) and metformin reduced BMI by 0.6 kg/m2 (95% CI: −1.1, −0.1). However, compared to the self-directed group, the coach-directed group unexpectedly increased SU by 0.3 mg/dL (95% CI: 0.05, 0.6), and metformin non-significantly increased SU by 0.2 mg/dL (95% CI: −0.04, 0.5); these effects were attenuated when analyses included change in estimated glomerular filtration rate (eGFR). Conclusions: In this randomized trial of cancer survivors without gout, reductions in BMI either increased or did not change SU, potentially due to effects on eGFR. These results do not support a focus on BMI reduction for SU reduction; however, long-term studies are needed. ClinicalTrials.gov Registration: NCT02431676.
AB - Background: Lower body mass index (BMI) has been associated with lower serum urate (SU), but only in observational studies. We sought to determine the effects of behavioral weight loss and metformin treatment on SU in a randomized trial. Methods and Findings: The Survivorship Promotion In Reducing IGF-1 Trial (SPIRIT) was a parallel three-arm randomized controlled trial of overweight/obese adult cancer survivors without gout at a single center in Maryland, United States. Participants were randomized to: (1) coach-directed weight loss (behavioral telephonic coaching), (2) metformin (up to 2000 mg daily), or (3) self-directed weight loss (informational brochures; reference group). SU and BMI were assessed at baseline and at 3, 6, and 12 months post-randomization. The 121 participants had a mean ± standard deviation (SD) age of 60 ± 9 years, 79% were female, and 45% were Black. At baseline, BMI was 35 ± 5 kg/m2, and SU was 5.6 ± 1.3 mg/dL. Compared to the self-directed group, at 12 months, the coach-directed group reduced BMI by 0.9 kg/m2 (95% confidence interval (CI): −1.5, −0.4) and metformin reduced BMI by 0.6 kg/m2 (95% CI: −1.1, −0.1). However, compared to the self-directed group, the coach-directed group unexpectedly increased SU by 0.3 mg/dL (95% CI: 0.05, 0.6), and metformin non-significantly increased SU by 0.2 mg/dL (95% CI: −0.04, 0.5); these effects were attenuated when analyses included change in estimated glomerular filtration rate (eGFR). Conclusions: In this randomized trial of cancer survivors without gout, reductions in BMI either increased or did not change SU, potentially due to effects on eGFR. These results do not support a focus on BMI reduction for SU reduction; however, long-term studies are needed. ClinicalTrials.gov Registration: NCT02431676.
KW - Metformin
KW - Randomized clinical trial
KW - Serum urate
KW - Uric acid
KW - Weight loss
UR - http://www.scopus.com/inward/record.url?scp=85111597519&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85111597519&partnerID=8YFLogxK
U2 - 10.3390/nu13082673
DO - 10.3390/nu13082673
M3 - Article
C2 - 34444833
AN - SCOPUS:85111597519
SN - 2072-6643
VL - 13
JO - Nutrients
JF - Nutrients
IS - 8
M1 - 2673
ER -