Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective cohort studies
PubMed 31061018 · doi:10.1136/bmjopen-2018-024171
What was done
The authors conducted a systematic review and meta-analysis of prospective cohort studies searched in MEDLINE, Embase, and Cochrane Library through September 13, 2017. They assessed relations between food sources of fructose-containing sugars (sugar-sweetened beverages, fruit juices, and whole fruits) and incident gout or hyperuricaemia. Two independent reviewers extracted data and assessed risk of bias. Natural-log transformed risk ratios (RRs) for highest versus lowest intake from the most-adjusted models were pooled using random-effects generic inverse variance models. Overall certainty was graded using GRADE.
What was found
Three prospective cohort studies (154,289 participants, 1,761 gout cases) were included; none reported incident hyperuricaemia. Comparing highest to lowest intake categories in multivariable-adjusted models: - Sugar-sweetened beverages (SSBs): RR 2.08 (95% CI 1.40 to 3.08), moderate certainty. - Fruit juice: RR 1.77 (95% CI 1.20 to 2.61), very low certainty. - Fruit: RR 0.85 (95% CI 0.63 to 1.14), very low certainty.
Why it matters
This review demonstrates that while liquid fructose sources like sugar-sweetened beverages and fruit juices are linked to higher gout incidence, whole fruit consumption is not associated with increased risk.
Limits
Only three prospective cohort studies were available, limiting statistical power and generalizability. No studies evaluated incident hyperuricaemia. As an observational meta-analysis, residual dietary confounding cannot be ruled out, and the evidence certainty for fruit juice and fruit intake was rated very low.
Cited by
- supports Fructose metabolism converts directly into uric acid, exacerbating gout.