Soft Drinks, Fructose Consumption, and the Risk of Gout in Men: Prospective Cohort Study

Overview

Journal BMJ

Specialty General Medicine

Date 2008 Feb 5

PMID 18244959

Citations 176

Authors

Hyon K Choi

Gary Curhan

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the relation between intake of sugar sweetened soft drinks and fructose and the risk of incident gout in men.

Design: Prospective cohort over 12 years.

Setting: Health professionals follow-up study.

Participants: 46 393 men with no history of gout at baseline who provided information on intake of soft drinks and fructose through validated food frequency questionnaires.

Main Outcome Measure: Incident cases of gout meeting the American College of Rheumatology survey criteria for gout.

Results: During the 12 years of follow-up 755 confirmed incident cases of gout were reported. Increasing intake of sugar sweetened soft drinks was associated with an increasing risk of gout. Compared with consumption of less than one serving of sugar sweetened soft drinks a month the multivariate relative risk of gout for 5-6 servings a week was 1.29 (95% confidence interval 1.00 to 1.68), for one serving a day was 1.45 (1.02 to 2.08), and for two or more servings a day was 1.85 (1.08 to 3.16; P for trend=0.002). Diet soft drinks were not associated with risk of gout (P for trend=0.99). The multivariate relative risk of gout according to increasing fifths of fructose intake were 1.00, 1.29, 1.41, 1.84, and 2.02 (1.49 to 2.75; P for trend <0.001). Other major contributors to fructose intake such as total fruit juice or fructose rich fruits (apples and oranges) were also associated with a higher risk of gout (P values for trend <0.05).

Conclusions: Prospective data suggest that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Diet soft drinks were not associated with the risk of gout.

Citing Articles

Conducting genetic epidemiology research on hyperuricaemia and gout in an indigenous community in Guam - a feasibility study.

Paulino Y, Camacho F, Paulino T, Lee D, Natividad L, Matisoo-Smith E BMC Public Health. 2025; 25(1):484.

PMID: 39910506 PMC: 11800552. DOI: 10.1186/s12889-025-21643-5.

Dietary Fructose: A Literature Review of Current Evidence and Implications on Metabolic Health.

Agarwal V, Das S, Kapoor N, Prusty B, Das B Cureus. 2024; 16(11):e74143.

PMID: 39712814 PMC: 11663027. DOI: 10.7759/cureus.74143.

The pathogenesis of gout.

Ahn E, So M J Rheum Dis. 2024; 32(1):8-16.

PMID: 39712248 PMC: 11659655. DOI: 10.4078/jrd.2024.0054.

Acute heat stress upregulates Akr1b3 through Nrf-2 to increase endogenous fructose leading to kidney injury.

Wang S, Pang X, Cai Y, Tian X, Bai J, Xi M J Biol Chem. 2024; 301(2):108121.

PMID: 39710324 PMC: 11834071. DOI: 10.1016/j.jbc.2024.108121.

Association between Uric Acid Levels and the Consumption of Sugar-Sweetened Carbonated Beverages in the Korean Population: The 2016 Korea National Health and Nutrition Examination Survey.

Lee S, Lee S, Park E, Lee Y, Choi J, Lee S Nutrients. 2024; 16(13).

PMID: 38999914 PMC: 11243194. DOI: 10.3390/nu16132167.

References

Choi H, Ford E, Li C, Curhan G . Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2007; 57(1):109-15. DOI: 10.1002/art.22466. View

Wallace S, Robinson H, MASI A, Decker J, McCarty D, Yu T . Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977; 20(3):895-900. DOI: 10.1002/art.1780200320. View

Sharpe C . A case-control study of alcohol consumption and drinking behaviour in patients with acute gout. Can Med Assoc J. 1984; 131(6):563-7. PMC: 1483603. View

Fox I, Palella T, Kelley W . Hyperuricemia: a marker for cell energy crisis. N Engl J Med. 1987; 317(2):111-2. DOI: 10.1056/NEJM198707093170209. View

Bray G, Nielsen S, Popkin B . Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr. 2004; 79(4):537-43. DOI: 10.1093/ajcn/79.4.537. View

Rimm E, Giovannucci E, Stampfer M, Colditz G, Litin L, Willett W . Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. 1992; 135(10):1114-26; discussion 1127-36. DOI: 10.1093/oxfordjournals.aje.a116211. View

Gross L, Li L, Ford E, Liu S . Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr. 2004; 79(5):774-9. DOI: 10.1093/ajcn/79.5.774. View

Hallfrisch J, Ellwood K, Michaelis 4th O, Reiser S, ODorisio T, PRATHER E . Effects of dietary fructose on plasma glucose and hormone responses in normal and hyperinsulinemic men. J Nutr. 1983; 113(9):1819-26. DOI: 10.1093/jn/113.9.1819. View

Zavaroni I, Sander S, Scott S, Reaven G . Effect of fructose feeding on insulin secretion and insulin action in the rat. Metabolism. 1980; 29(10):970-3. DOI: 10.1016/0026-0495(80)90041-4. View

10.

Joshipura K, Hu F, Manson J, Stampfer M, Rimm E, Speizer F . The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med. 2001; 134(12):1106-14. DOI: 10.7326/0003-4819-134-12-200106190-00010. View

11.

Anderson J, Story L, Zettwoch N, Gustafson N, Jefferson B . Metabolic effects of fructose supplementation in diabetic individuals. Diabetes Care. 1989; 12(5):337-44. DOI: 10.2337/diacare.12.5.337. View

12.

Nakagawa T, Tuttle K, Short R, Johnson R . Hypothesis: fructose-induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome. Nat Clin Pract Nephrol. 2006; 1(2):80-6. DOI: 10.1038/ncpneph0019. View

13.

Thorburn A, Storlien L, Jenkins A, Khouri S, Kraegen E . Fructose-induced in vivo insulin resistance and elevated plasma triglyceride levels in rats. Am J Clin Nutr. 1989; 49(6):1155-63. DOI: 10.1093/ajcn/49.6.1155. View

14.

Lawrence R, Helmick C, Arnett F, Deyo R, Felson D, Giannini E . Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998; 41(5):778-99. DOI: 10.1002/1529-0131(199805)41:5<778::AID-ART4>3.0.CO;2-V. View

15.

Choi H, Curhan G . Gout: epidemiology and lifestyle choices. Curr Opin Rheumatol. 2005; 17(3):341-5. View

16.

FALLER J, Fox I . Ethanol-induced hyperuricemia: evidence for increased urate production by activation of adenine nucleotide turnover. N Engl J Med. 1982; 307(26):1598-602. DOI: 10.1056/NEJM198212233072602. View

17.

Choi H, Atkinson K, Karlson E, Willett W, Curhan G . Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004; 350(11):1093-103. DOI: 10.1056/NEJMoa035700. View

18.

Rizkalla S, Boillot J, Tricottet V, Fontvieille A, Luo J, Salzman J . Effects of chronic dietary fructose with and without copper supplementation on glycaemic control, adiposity, insulin binding to adipocytes and glomerular basement membrane thickness in normal rats. Br J Nutr. 1993; 70(1):199-209. DOI: 10.1079/bjn19930117. View

19.

Campion E, Glynn R, DeLabry L . Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med. 1987; 82(3):421-6. DOI: 10.1016/0002-9343(87)90441-4. View

20.

Schulze M, Manson J, Ludwig D, Colditz G, Stampfer M, Willett W . Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004; 292(8):927-34. DOI: 10.1001/jama.292.8.927. View