Consumption of sugar-sweetened beverages (SSBs) was associated with increased risk for incident gout, according to results of a meta-analysis published in BMJ Open. A similar effect was found for fruit juice intake, although not for consumption of whole fruit.
Investigators conducted a systematic search of MEDLINE, Embase, and the Cochrane Library from inception through September 13, 2017. Prospective cohort studies of ≥1 year duration that investigated the relationship between food sources of sugar and incident gout were selected for inclusion. Two independent reviewers extracted study data and assessed risk for bias. The primary outcome measure was incident gout or hyperuricemia. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
Of 309 publications identified, 3 prospective cohort studies met inclusion criteria: the Nurses’ Health Study, Health Professionals Follow-up Study, and National Runners’ Health Study. Together, these reports comprised information from 154,289 participants, among whom 1761 presented with incident cases of gout. Studies had a median follow-up period of 17 (range, 12-22) years for SSB consumption, 18.7 (range, 12-22) years for fruit juice, and 9.9 (range, 7.74-12) years for whole fruit.
The researchers performed dietary intake assessments with self-reported food frequency questionnaires in all sources. No study detected any evidence of serious risk for bias. Comparing the highest with the lowest intake of fruit juice, investigators found a significant adverse association between fruit juice consumption and incident gout (risk ratio, 1.77; 95% CI, 1.20-2.61). Similarly, they determined that the greatest SSB intake was significantly associated with incident gout (risk ratio, 2.08; 95% CI, 1.40-3.08) when compared with the lowest SSB intake. The researchers determined no association between whole fruit intake and incident gout (risk ratio, 0.85; 95% CI, 0.63-1.14), although they did detect significant interstudy heterogeneity for this calculation. According to GRADE analyses, the researchers found the strongest evidence for the adverse association with SSB intake (moderate certainty) and the weakest for the adverse association with fruit juice intake (very low certainty) and the lack of association with fruit intake (very low certainty).
These data strongly suggest an adverse effect of SSB consumption on incident gout risk, with a similar effect of lower certainty observed for fruit juice. These effects do not appear to extend to whole fruit intake. Further research is necessary to confirm these findings and investigate the dose-response relationship between fructose consumption and gout risk.
Ayoub-Charette S, Liu Q, Khan TA, et al. Important food sources of fructose containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies. BMJ Open. 2019;9(5):e024171.