June 11, 2019
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Sugar-sweetened beverages linked to 208% increase in incident gout

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A “moderate certainty of evidence” showed that sugar-sweetened beverages are associated with a 208% increase in incident gout, when comparing intake levels, according to data published in BMJ Open.

The researchers also found a “very low” certainty of evidence that fruit juice was linked to a 77% increase in incident gout.

“Ingestion of large amounts of the monosaccharide fructose can increase uric acid production during its metabolism in the liver through unregulated phosphorylation of ATP into adenosine monophosphate (AMP) as demonstrated in randomized controlled trials,” John L. Sievenpiper, MD, PhD, FRCPC, of St. Michael’s Hospital, in Toronto, and colleagues said. “Similarly, in cohort studies, high intake of fructose-containing sugars in the form of sugar-sweetened beverages (SSBs) is associated with incident gout.

“It is unclear whether the association seen for SSBs intake holds for other important food sources of fructose-containing sugars, such as fruit and fruit-based products, grains and grain-based products, dairy and dairy-based products and sweets and desserts,” they added. “As dietary guidelines and public health policy move from nutrient-based recommendations toward food and dietary-based recommendations, it is important to understand the contribution of these different food sources of fructose-containing sugars to the association of incident gout.”

To evaluate the link between fructose-containing sugars and incident gout, Sievenpiper and colleagues conducted a systematic review and meta-analysis of prospective cohort studies. Searching Medline and the Cochrane Library through Sept. 13, 2017, the researchers initially identified 309 reports on the relationship between food sources of sugar and incident gout or hyperuricemia. Of those, 294 were excluded based on title or abstract, and 15 were read in full. Ultimately, the researchers included three articles in their analysis, representing 154,289 participants with 1,761 incident cases of gout.

Among the included articles, two each reported data on fruit intake, fruit juice and sugar-sweetened beverages, and none studied links to incident hyperuricemia. The researchers used these data to compare patients with the highest exposure levels for fruit, fruit juice and sugar-sweetened beverages with those reporting the lowest intake. They used pooled natural-log transformed risk ratios using the generic inverse variance method with random effects model. The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.

According to the researchers, intake of fruit juice (RR = 1.77; 95%CI, 1.2-2.61) and sugar-sweetened beverages (RR = 2.08; 95%CI, 1.4-3.08) both demonstrated an adverse association with incident gout, when comparing the highest to lowest intake of the most adjusted models. Meanwhile, there was no significant link between fruit intake and gout. The strongest evidence — which was of a moderate certainty — pointed toward an adverse association with sugar-sweetened beverages and gout. The weakest evidence — a very low certainty — suggested an adverse association with fruit juice.

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“The pooled analyses revealed that there was moderate certainty of evidence that SSB intake was associated with a 208% increase in incident gout when comparing the highest with the lowest intake,” Sievenpiper and colleagues wrote. “There was very low certainty of evidence that fruit juice intake was associated with a 77% increase in incident gout and that fruit intake was not associated with incident gout. There was no data available for other important food sources of fructose-containing sugars.”

“Given that incident gout is rising in many countries and that gout and hyperuricemia are both associated with metabolic syndrome, myocardial infarction, diabetes and premature death, it is becoming increasingly important to identify and understand risk factors for developing gout,” they added. “It is imperative for additional prospective studies to assess the intake of various food sources of fructose-containing sugars and their relationship with gout and hyperuricemia in diverse populations.” – by Jason Laday

Disclosure: Sievenpiper reports funding from a PSI Graham Farquharson Knowledge Translation Fellowship, a Canadian Diabetes Association (CDA) Clinician Scientist award, a Canadian Institutes of Health Research (CIHR) Institute of Nutrition, Metabolism and Diabetes (INMD)/Canadian Nutrition Society (CNS) New Investigator Partnership Prize and a Banting & Best Diabetes Centre Sun Life Financial New Investigator Award.