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

OBJECTIVE: To compare three calorie-restricted diets for weight loss, serum urate (SU) value, early urate dynamics, gout flares, adherence, and body composition in men with overweight or obesity and hyperuricemia. RESEARCH DESIGN AND METHODS: In this 12-week, open-label, active-comparator randomized trial, 102 men with overweight or obesity and hyperuricemia were assigned 1:1:1 to a carbohydrate-restricted diet (CRD), Dietary Approaches to Stop Hypertension (DASH) diet, or low-purine balanced diet (LPBD). All groups followed a calorie-restricted prescription of 20-25 kcal/kg ideal body weight. The primary end point was change in SU from baseline to week 12. RESULTS: Of 102 randomized participants, 85 (83.3%) completed follow-up. At week 12, mean weight loss was 8.47 kg (9.3%) with no between-group difference (P = 0.99). Adjusted SU changes were -0.89 mg/dL with the CRD, -0.79 mg/dL with the DASH diet, and -0.50 mg/dL with the LPBD, without a significant between-group difference (P = 0.48). Capillary blood urate monitoring identified a transient week 1 increase coinciding with the early peak in gout flares. Dietary adherence to DASH was higher than to the other two diets and was associated with less soft lean mass loss than the CRD. CONCLUSIONS: In men with overweight or obesity and hyperuricemia, three calorie-restricted dietary patterns produced substantial weight loss but did not differ significantly in 12-week SU reduction. DASH was associated with higher adherence than both the CRD and LPBD and with less soft lean mass loss than the CRD. Early urate instability and coincident gout flares highlight the need for flare-risk management during structured dietary weight-loss initiation.