Highlight
- Three calorie-restricted diets—DASH, carbohydrate-restricted, and low-purine balanced—produce substantial weight loss in men with overweight or obesity and hyperuricemia.
- All diets lead to comparable reductions in serum urate levels over 12 weeks, with no statistically significant differences.
- The DASH diet showed higher dietary adherence and less soft lean mass loss compared to the carbohydrate-restricted diet.
- Early transient increases in serum urate during week 1 correlate with increased gout flares, underscoring flare-risk management during weight loss initiation.
Study Background
Hyperuricemia, characterized by elevated serum urate (SU) levels, is a critical risk factor for gout and is frequently associated with overweight and obesity. Managing hyperuricemia through lifestyle modifications, including diet, has become a central component of treatment. Although various diet patterns such as the Dietary Approaches to Stop Hypertension (DASH), carbohydrate-restricted, and low-purine diets have been proposed to reduce SU levels and promote weight loss, direct comparisons in controlled trials are limited. Weight loss itself improves urate control, but differential effects of dietary macronutrient composition on serum urate dynamics, body composition, and gout flare incidence in hyperuricemic patients remain inadequately understood.
Study Design
This was a 12-week, open-label, active-comparator randomized trial involving 102 men diagnosed with overweight or obesity (body mass index [BMI] criteria consistent with overweight/obese categories) and hyperuricemia. Participants were randomly assigned in equal proportions (1:1:1) to one of three calorie-restricted dietary interventions:
- Carbohydrate-Restricted Diet (CRD): Reduced carbohydrate intake within a calorie-restricted framework.
- DASH Diet: Emphasizes fruits, vegetables, low-fat dairy, and reduced saturated fat, aligned with calorie restriction.
- Low-Purine Balanced Diet (LPBD): Focused on limiting dietary purines while maintaining calorie restriction.
Each diet prescribed a calorie intake of 20-25 kcal/kg of ideal body weight to promote weight loss. The primary endpoint was the change in serum urate from baseline to week 12. Secondary outcomes included weight loss magnitude, early serum urate dynamics, gout flare occurrence, dietary adherence, and changes in body composition, particularly soft lean mass.
Key Findings
Of the 102 randomized subjects, 85 (83.3%) completed the study. Mean weight loss at 12 weeks was substantial and clinically meaningful across all dietary groups, averaging 8.47 kg (9.3% of baseline weight), with no statistically significant differences between groups (P = 0.99).
Serum urate level decreased in all groups. Adjusted mean SU reductions were:
- CRD: -0.89 mg/dL
- DASH: -0.79 mg/dL
- LPBD: -0.50 mg/dL
No significant difference in SU change between diets was detected (P = 0.48).
An important observation was a transient rise in serum urate during the first week, detected via capillary blood monitoring, which corresponded temporally to an increased incidence of gout flares early in the intervention. This early urate instability suggests that initiating weight loss through dietary modification may temporarily exacerbate gout symptoms.
Dietary adherence was notably higher in the DASH diet group compared to both CRD and LPBD groups. Furthermore, body composition analyses revealed that the DASH diet resulted in less loss of soft lean mass compared to the carbohydrate-restricted diet, implying better preservation of muscle mass during weight reduction.
Expert Commentary
This trial provides valuable head-to-head data on three commonly recommended dietary patterns for men with hyperuricemia and excess weight. The comparable efficacy in serum urate reduction suggests flexibility in dietary choices based on patient preference, metabolic goals, and tolerability.
The higher adherence and preservation of lean mass associated with the DASH diet may confer clinical advantages, as adherence is a major determinant of long-term success and lean mass preservation has implications for metabolic health and physical function.
The early surge in serum urate and coincident gout flares emphasize the need for anticipatory clinical strategies, such as prophylactic anti-inflammatory therapy or tailored monitoring during diet initiation. This phenomenon corroborates earlier evidence linking rapid urate mobilization after weight loss onset to gout flare risk.
Limitations include the open-label design and relatively short duration. Longer-term studies are needed to assess sustainability, long-term urate control, and health outcomes, including cardiovascular and renal effects.
Conclusion
In men with overweight or obesity and hyperuricemia, calorie-restricted DASH, carbohydrate-restricted, and low-purine balanced diets lead to significant weight loss and meaningful reductions in serum urate over 12 weeks without significant differences between them. The DASH diet stands out for better adherence and lean mass preservation.
Clinicians should be aware of early urate fluctuations and risk of gout flares when initiating weight loss diets, advocating appropriate flare-risk management during this period.
This evidence supports patient-centered dietary recommendations permitting flexibility to optimize adherence and metabolic outcomes while managing hyperuricemia and gout risk.
Funding and Trial Registration
The trial was reported by Liu et al. in Diabetes Care (2026); further details regarding funding sources and clinical trial registration were not provided in the original abstract.
References
- Liu S, Yan L, Huang Y, et al. Calorie-Restricted DASH, Carbohydrate-Restricted, and Low-Purine Diets for Weight Loss and Urate Control in Men With Overweight or Obesity and Hyperuricemia: A Randomized Trial. Diabetes Care. 2026 Sep 15. PMID: 42743064.
- Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. Am J Med. 2007;120(5):442-447.
- Dalbeth N, Merriman TR, Stamp LK. Mechanisms of gout. Lancet. 2016;388(10055):2039-2052.
- Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997;336(16):1117-1124.
