From the Guidelines
Obesity is the most prevalent risk factor for the development of gout among the options listed. Obesity contributes to gout development through several mechanisms, including increasing uric acid production and decreasing its excretion by the kidneys, leading to hyperuricemia (elevated uric acid levels in the blood) 1. This creates favorable conditions for urate crystal formation in joints, which triggers the inflammatory response characteristic of gout attacks. Additionally, obesity is associated with insulin resistance, which further impairs renal uric acid excretion. While occupation (construction worker), gender (premenopausal women actually have lower gout risk due to estrogen's uricosuric effect), and poor nutrition can influence gout risk to some degree, obesity has the strongest and most direct relationship with gout development, as supported by the 2020 European League Against Rheumatism evidence-based recommendations for the diagnosis of gout 1.
Some key points to consider:
- Obesity is a major risk factor for gout, and weight loss is a key non-pharmacological intervention for both preventing gout and reducing attack frequency in those already diagnosed with the condition 1.
- The 2017 American College of Physicians clinical practice guideline for the management of acute and recurrent gout also highlights the importance of lifestyle modifications, including weight loss, in managing gout 1.
- The 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout emphasize the need to identify and address person-specific risk factors for hyperuricaemia, including overweight and obesity 1.
Overall, obesity is the most significant risk factor for gout development among the options listed, and addressing obesity through weight loss and lifestyle modifications is crucial for preventing and managing gout.
From the Research
Risk Factors for Gout Development
The development of gout is influenced by various risk factors, including:
- Male sex
- Obesity
- Hypertension
- Alcohol intake
- Diuretic use
- Diet rich in meat and seafood
- Chronic kidney disease
- Diet heavy in fructose-rich food and beverages
- Certain ethnic groups
- Living in high-income countries 2, 3
Comparison of Given Options
Comparing the given options:
- Construction worker: No direct evidence linking this occupation to a higher risk of gout development
- Premenopausal women: Gout is less prevalent in women, especially premenopausal women 3, 4
- Obesity: Established as a significant risk factor for gout development 2, 3, 4
- Poor nutrition: While diet plays a role in gout development, the term "poor nutrition" is broad and not specifically defined in the context of gout risk factors 2, 3, 5
Prevalence of Risk Factors
Based on the provided evidence, obesity is the most prevalent risk factor for the development of gout among the given options 2, 3, 4. Obesity, excessive weight gain, and hypertension are identified as significant risk factors for gout development 4.