Consumption of excess free fructose (EFF) beverages was associated with an increased prevalence of arthritis in adults in the United States between 20 and 30 years of age, according to data published in Nutrition & Diabetes. These results suggest that unabsorbed EFF and the resulting advanced glycation end-products derived from the metabolism of excess free fructose [enFruAGEs] may play a role in the pathogenesis of arthritis in young adults.
The study included 1209 adults from the Nutrition and Health Examination Surveys between 2003 and 2006. Researchers examined high EFF exposure variables including soft drinks sweetened with high-fructose corn syrup, fruit drinks, and apple juice. An analysis of diet soda and diet fruit drinks was also conducted. Participants self-reported arthritis status.
“Results support the possibility that there exists a nexus between fructose malabsorption, regular EFF consumption, and increased odds and arthritis prevalence in US adults aged 20-30 years,” the authors wrote. “Unabsorbed excess free fructose may interact with dietary proteins resulting in the in situ formation of enFruAGEs that may play a role in the idiopathic link between gut and joint inflammation.”
Young adults who consumed any combination of high EFF beverages, excluding diet soda, were more than 5 times a week were 3 times as likely to have arthritis compared with non or low consumers (odds ratio: 3.01; 95% confidence interval: 1.20-7.59; P<.021). The results were independent of all covariates including physical activity, other dietary factors, blood glucose levels, and smoking status.
“Study results are consistent with the possibility that enFruAGEs are an overlooked source of that may contribute to arthritis pathogenesis in young adults,” the authors concluded. “Longitudinal and biochemical research are needed to confirm and clarify the mechanisms involved.”
Summary and Clinical Applicability
Previous studies have indicated that regular consumption of soft drinks sweetened with high-fructose corn syrup, but not diet soft drinks, may be associated with increased risk of seropositive rheumatoid arthritis (RA) in women. Researchers speculate that fructose malabsorption due to regular consumption of EFF travel through intestinal boundaries to other tissues, which results in further inflammation. Other studies have previously observed an association between accumulation of enFruAGEs and joint inflammation in RA.
Researchers of the current study found a significant association between EFF beverage intake and non-age, non-wear and tear-associated arthritis in young adults in the United States. They suggest that this association may be caused by intestinal in situ formation of enFruAGEs, and further biochemical research should be conducted to determine which mechanisms are involved in the pathogenesis of arthritis in this population.
DeChristopher LR, Uribarri J, Tucker KL. Intake of high-fructose corn syrup sweetened soft drinks, fruit drinks and apple juice is associated with prevalent arthritis in US adults, aged 20-30 years. Nutrition & Diabetes. 2016; doi: 10.1038/nutd.2016.7.