Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study

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.

Multivariate relative risk of incident gout in 46 393 men from health professionals follow-up study, according to fifths of free fructose intake in subgroups. Reference group for comparisons was men in lowest fifth of fructose intake and (top) with body mass index <25 kg/m2, (middle) no alcohol use, and (bottom) total daily dairy intake ≤1.6 servings. Relative risks were adjusted for age, total energy intake, body mass index, diuretic use, history of hypertension, history of renal failure, intake of alcohol, intake of total vitamin C, and percentage of energy from total carbohydrate and protein