OBJECTIVE: Our objective was to evaluate associations of weight reduction with serum urate (SU) changes and achieving an SU level <
6 mg/dL in the real-world setting, outside of specific weight reduction interventions. METHODS: We analyzed systematically collected data of annual medical examination participants from October 2012 to October 2022. Exposure was weight change (increase or decrease) between two consecutive visits, categorized as minimal (≤0.9 kg, reference), small (1.0-4.9 kg), moderate (5.0-9.9 kg), and large (≥10 kg). Outcomes included SU changes between two consecutive visits and achieving an SU level <
6 mg/dL in participants with hyperuricemia (SU level ≥7 mg/dL at the previous visit). RESULTS: We identified 58,630 eligible participants (median age 46 years, 51.3% female, 19.4% with overweight, median SU level 5.3 mg/dL, and 5.6% with a history of gout and/or hyperuricemia) with 336,814 visits over a median of 5.3 years. After adjustment for relevant covariates, linear general estimating equations estimated mean SU changes based on observed weight reductions (vs minimal changes) were as follows: small, -0.10 mg/dL (95% confidence interval [CI] -0.10 to -0.09 mg/dL)
moderate, -0.34 mg/dL (95% CI -0.36 to -0.32 mg/dL)
and large, -0.64 (95% CI -0.70 to -0.58 mg/dL). In participants with hyperuricemia, adjusted relative risks for achieving an SU level <
6 mg/dL by modified Poisson regression were 1.25 (95% CI 1.15-1.37) in small weight reductions, 2.82 (95% CI 2.43-3.27) in moderate weight reductions, and 5.27 (95% CI 4.15-6.70) in large weight reductions, with corresponding numbers needed to treat of 61.1 for small weight reductions, 8.5 for moderate weight reductions, and 3.6 for large weight reductions. CONCLUSION: Small weight reductions were associated with only small SU changes. Some participants with hyperuricemia can achieve the target SU level with moderate to large weight reductions.