Impact of 8-Hour Time-Restricted Eating on Energy Intake, Macronutrient Distribution, and Appetite in Middle-Aged Females With Overweight/Obesity: A Secondary Analysis

Objectives: High serum urate (SU) levels are a causal risk factor for gout.Diet is known to modulate SU levels, but no systematic work has been conducted to derive dietary patterns that predict SU levels and to understand their relationship with the risk of gout and related cardiometabolic diseases.To derive a dietary pattern that predicts lower SU levels and to examine this diet in relation to the risk of gout and cardiometabolic conditions, including hypertension, CHD, stroke, and type 2 diabetes (T2D).Methods: A food-based Empirical Dietary Index for Eu-Uricemia (EDIEU) was developed using 7-day diet record data and SU through the Least Absolute Shrinkage and Selection Operator (LASSO) among participants with low eGFR in the Lifestyle Validation Study (LVS).The EDIEU was subsequently validated in the Mind Body Study (MBS) and NHANES.Prospective associations between EDIEU and gout and cardiometabolic diseases were examined using multivariable Cox regression in the Nurses' Health Study and Health Professionals Follow-up Study.Results: The LASSO analysis identified blueberries, cheese, grapes, and low-fat milk as negative predictors of SU, as well as artificially-sweetened beverages, red meat, liquor, liver, mixed vegetables, salad dressing, tomato products, and wine as positive predictors.The EDIEU positively weighted negative SU predictors and the vice versa for positive predictors and showed a Spearman correlation coefficient of -0.23 with SU levels in LVS among those with low eGFR (MBS: -0.14; NHANES: -0.33).In the entire cohort population, a higher EDIEU was associated with a lower risk of gout (HR comparing the extreme quintiles: 0.48; 95% CI: 0.42-0.55).The association was consistent by sex, genetic susceptibility of uricemia, and lifestyle factors.A higher EDIEU was associated with lower risks of incident hypertension (HR: 0.84, 0.81-0.86),stroke (0.85, 0.78-0.92),and T2D (0.89, 0.84-0.94),but not CHD (1.00, 0.95-1.05).These associations were robust when we used different weights or non-parametric approaches to derive the EDIEU.Conclusions: A replicated empirical index predicting lower SU was associated with a substantially lower risk of gout, as well as hypertension, stroke, and T2D.Consuming such a diet with lower uricemia potentials could be an effective approach to preventing gout and related cardiometabolic conditions.