Fructose-Rich Beverages and Risk of Gout in Women
Hyon K. Choi, MD, DrPH;
Walter Willett, MD, DrPH;
Gary Curhan, MD, ScD
JAMA. 2010;304(20):2270-2278. doi:10.1001/jama.2010.1638
Context Fructose-rich beverages such as sugar-sweetened soda and orange juice can increase serum uric acid levels and, thus, the risk of gout, but prospective data on the relationship are limited.
Objective To examine the relationship between intake of fructose-rich beverages and fructose and the risk of incident gout among women.
Design, Setting, and Participants In the Nurses’ Health Study, a US prospective cohort study spanning 22 years (1984-2006), we analyzed data from 78 906 women with no history of gout at baseline who provided information on intake of beverages and fructose through validated food frequency questionnaires.
Main Outcome Measure Incident cases that met the American College of Rheumatology survey criteria for gout.
Results During 22 years of follow-up, we documented 778 confirmed incident cases of gout. Increasing intake of sugar-sweetened soda was independently associated with increasing risk of gout. Compared with consumption of less than 1 serving per month of sugar-sweetened soda, the multivariate relative risk of gout for 1 serving per day was 1.74 (95% confidence interval [CI], 1.19-2.55) and for 2 or more servings per day was 2.39 (95% CI, 1.34-4.26) (P<.001 for trend). The corresponding relative risks for orange juice were 1.41 (95% CI, 1.03-1.93) and 2.42 (95% CI, 1.27-4.63) (P = .02 for trend). The absolute risk differences corresponding to these relative risks were 36 and 68 cases per 100 000 person-years for sugar-sweetened soda and 14 and 47 cases per 100 000 person-years for orange juice, respectively. Diet soft drinks were not associated with the risk of gout (P = .27 for trend). Compared with the lowest quintile of fructose intake, the multivariate relative risk of gout in the top quintile was 1.62 (95% CI, 1.20-2.19; P = .004 for trend) (risk difference of 28 cases per 100 000 person-years).
Conclusion Among this cohort of women, consumption of fructose-rich beverages is associated with an increased risk of incident gout, although the contribution of these beverages to the risk of gout in the population is likely modest given the low incidence rate among women.
Authors Affiliations: Section of Rheumatology and Clinical Epidemiology Unit, Boston University School of Medicine (Dr Choi), Channing Laboratory (Drs Choi, Willett, and Curhan), Department of Epidemiology, Harvard School of Public Health (Drs Willett and Curhan), and Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School (Dr Curhan), Boston, Massachusetts.