Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study.
Level 3 - non-randomized controlled study
Prospective non-randomized cohort study
PubMed 18244959 · doi:10.1136/bmj.39449.819271.BE
What was done
A 12-year prospective cohort study followed 46,393 men from the Health Professionals Follow-up Study who had no baseline history of gout. Dietary intake of sugar-sweetened soft drinks, diet soft drinks, total fructose, fruit juices, and fructose-rich fruits (apples and oranges) was assessed using validated food frequency questionnaires. The primary outcome was incident gout meeting the American College of Rheumatology survey criteria.
What was found
Over 12 years of follow-up, 755 incident cases of gout were documented. Compared to consuming less than one serving of sugar-sweetened soft drinks per month, the multivariate relative risk (RR) of gout was 1.29 (95% CI 1.00 to 1.68) for 5-6 servings/week, 1.45 (95% CI 1.02 to 2.08) for 1 serving/day, and 1.85 (95% CI 1.08 to 3.16) for 2 or more servings/day (P for trend = 0.002). Diet soft drinks showed no association with gout (P for trend = 0.99). Across increasing fifths of fructose intake, multivariate RRs were 1.00, 1.29, 1.41, 1.84, and 2.02 (95% CI 1.49 to 2.75; P for trend < 0.001). Total fruit juice and fructose-rich fruits were also significantly associated with increased gout risk (P for trend < 0.05).
Why it matters
This study provides large prospective evidence that fructose and sugar-sweetened beverages, but not diet soft drinks, are independently associated with an elevated risk of incident gout in men.
Limits
The cohort was restricted entirely to male health professionals, limiting generalizability to women and non-health-professional populations. Dietary intake was self-reported via food frequency questionnaires, introducing potential misclassification. As an observational study, residual confounding cannot be ruled out.
Cited by
- supports Gout is caused by fructose, and the theory that dietary protein causes gout has been debunked.