As shown in Table 3, after removing the SNPs associated with confounding factors detected on Phenoscanner (listed in Supplementary File 4; Supplementary Table S17), the positive causal relationships found in primary analyses remained significant except the estimate between ALT and the risk of gout (OR (95% CI): 2.38 (0.77–7.34), p = 0.131, after adjustment), indicating that confounding factors are thought to be responsible for the finding between ALT and the risk of gout. This evidence concerns the gene GPT and gout.