Effect of omega-three supplementation on serum urate and gout flares in people with gout; a pilot randomized trial

Abstract

Objectives To determine the effect of omega-three supplementation with fish oil on serum urate, weight and body mass index (BMI) in people with gout. Methods A pilot 6-month, randomized, open-label clinical trial was undertaken in people with gout with serum urate ≥ 0.36 mmol/l. Forty participants were randomized to receive 6.2 g omega-3 fish oil daily or no fish oil for 24 weeks. Blood was obtained monthly for serum urate and red cell EPA (20:5n-3) DHA (22:6n-3) were measured using a blood spot collection system. Results There was no statistically significant difference in the mean (SEM) decrease in serum urate between baseline and week 24 between randomized groups: fish oil − 0.021 (0.02) mmol/l versus control − 0.006 (0.02) mmol/l. There was no significant difference in change in weight or BMI between baseline and week 24 between randomized groups. There was a statistically significant correlation between red cell omega-three concentrations and the total number of flares per participant between week 12 and week 24; total omega-three r = − 0.75 (p ≤ 0.001), EPA r = − 0.75 (p ≤ 0.001) and DHA r = -0.76 (p ≤ 0.001). In the omega-three fish oil group four participants reported gastrointestinal adverse effects definitely or probably related to the omega-three supplementation. Conclusions The lack of untoward effect of omega three fish oil supplementation on serum urate and BMI together with the relationship between higher omega-three concentrations and lower gout flares supports the development of further adequately powered clinical trials to determine the role of omega-three supplements as prophylaxis against gout flares in people starting urate lowering therapy. Clinical trial registration ACTRN12617000539336p Registered 13/04/2017.

Dissecting the causal effect between gut microbiota, DHA, and urate metabolism: A large-scale bidirectional Mendelian randomization

“…Some observational studies also suggested that ω-3 PUFAs, especially DHA were highly related to hyperuricemia ( 13 , 14 ). However, a recent clinical trial found no significant difference in the serum urate level between the 24-week ω-3 PUFAs supplement group and the control group ( 15 ). Since gut microbiota might confer an effect on the host health status by metabolizing PUFAs ( 16 ), we hereby hypothesize a potential mediation effect of gut microbiota on urate metabolism via PUFAs and their important subtypes, such as DHA.…”

Dietary Factors and Risk of Gout: A Two-Sample Mendelian Randomization Study

“…Fish oil may be a key ingredient in the prevention of gouty attacks, as it is rich in the omega-3 fatty acid, which has been widely reported to have anti-inflammatory activities [32]. Clinical research has found that fish oil supplementation contributes to lower serum uric acid levels and reduces the risk of gout [33,34]. In addition, this study found that poultry intake was a risk factor for gout by using the main method, IVW analysis.…”

Comparative Risk of Gout Flares When Initiating or Escalating Various Urate‐Lowering Therapy: A Systematic Review With Network Meta‐Analysis

“…Indirect inferences from other trials were again limited by trial reporting, wherein few trials reported flare rates for both the period during and immediately after prophylactic cessation. Identifying clinical characteristics that may alter an individual's susceptibility to gout flares when initiating or escalating ULT may be a useful approach to tailoring prophylactic use, and although research in this area is expanding, more adequately powered clinical trials to solidify the associations are required 62–66 . Additionally, established risk factors for flares, such as the presence of tophi, require quantifiable measurement by dual‐energy computed tomography 67 or ultrasonography 68 to accurately assess the risk, and access to these in practice may be limited.…”