Global burden of gout attributable to high BMI (1990-2021) and causal link with obesity: a GBD and Mendelian randomization study.

BACKGROUND

High body mass index (BMI ⩾25 kg/m2) is a critical driver of the global gout epidemic. We aimed to characterize the evolving burden of gout attributable to high BMI and establish the potential causal links between varying obesity grades and gout risk.

OBJECTIVES

We aimed to characterize the evolving burden of gout attributable to high BMI and establish the potential causal links between varying obesity grades and gout risk.

DESIGN

An observational global epidemiological analysis and a bidirectional two-sample Mendelian randomization (MR) study.

METHODS

Utilizing Global Burden of Disease (GBD) 2021 data, we analyzed disability-adjusted life years (DALYs) and age-standardized DALY rates across 204 countries. Trends were assessed via Joinpoint regression, decomposition, and inequality analyses. Future trajectories were projected using Bayesian age-period-cohort models. Bidirectional MR evaluated the causal impact of Class 1-3 obesity on gout, adjusting for multiple comparisons.

RESULTS

From 1990 to 2021, global DALYs for high BMI-related gout increased 2.26-fold, with a 56.9% rise in age-standardized DALY rates. While High-socio-demographic index (SDI) regions face the highest absolute burden, the fastest growth occurred in low-middle SDI regions, indicating a geographic shift. A significant "age-shift" was observed, with the burden increasingly affecting younger males. Epidemiological changes were the primary drivers. MR analysis provided evidence supporting a potential causal relationship between Class 1 and 3 obesity and gout (all odds ratios > 1), with no evidence of reverse causality. Projections suggest that the global age-standardized DALY rates will reach 7.1 per 100,000 by 2040.

CONCLUSION

The global burden of high BMI-related gout is escalating, driven by epidemiological transitions and rising risks in younger men. Genetic evidence supports weight management as a fundamental preventive pillar. Targeted interventions, particularly in rapidly urbanizing regions, are urgently needed to curb this health threat.

TRIAL REGISTRATION: Not applicable.