Objective To determine the association and prevalence of gout among overweight, obese, and morbidly obese segments of the US population. Methods Among participants (age ≥20 years) of the National Health and Nutrition Examination Surveys in 1988-1994 and 2007-2010, gout status was ascertained by self-report of a physician diagnosis. Body mass index (BMI) was examined in categories of <18.5 kg/m2, 18.5-24.9 kg/m2, 25-29.9 kg/m2, 30-34.9 kg/m2, and ≥35 kg/m2 and as a continuous variable. The cross-sectional association of BMI category with gout status was adjusted for demographic and obesity-related medical disorders. Results In the US, the crude prevalence of gout was 1-2% among participants with a normal BMI (18.5-24.9 kg/m2), 3% among overweight participants, 4-5% with class I obesity, and 5-7% with class II or class III obesity. The adjusted prevalence ratio comparing the highest to a normal BMI category was 2.46 (95% confidence interval [95% CI] 1.44-4.21) in 1988-1994 and 2.21 (95% CI 1.50-3.26) in 2007-2010. Notably, there was a progressively greater prevalence ratio of gout associated with successively higher categories of BMI. In both survey periods, for an average American adult standing 1.76 meters (5 feet 9 inches), a 1-unit higher BMI, corresponding to 3.1 kg (∼6.8 pounds) greater weight, was associated with a 5% greater prevalence of gout, even after adjusting for serum uric acid (P < 0.001). Conclusion Health care providers should be aware of the elevated burden of gout among both overweight and obese adults, applicable to both women and men, and observed among non-Hispanic whites, non-Hispanic African Americans, and Mexican Americans in the US.
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