Women who consume fructose-rich beverages, such as sugar-sweetened soft drinks and orange juice, are at an increased risk for gout, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.

Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms of gout usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and needle‐like crystals deposit in the joints. This may happen because either uric acid production increases or, more often, the kidneys are unable to remove uric acid from the body adequately.

Fructose-rich, sugar-sweetened beverages may increase serum uric acid and the risk for gout.

Researchers have recently noted that the prevalence and incidence of gout has been in the rise in the United States over the past few decades and this has coincided with a substantial increase in soft drink and fructose consumption in the U.S. With this knowledge, a group of researchers recently set out to examine the relationship between intake of fructose-rich soft drinks and orange juice and the risk of gout in women.

The investigators examined over a 22-year period the relationship between the intake of these beverages and the risk of gout in 78,906 women who were participants in the Nurses’ Health Study. They used a questionnaire to determine if participants met any of the ACR’s criteria for gout and estimated each participant’s future risk for gout after considering things such as age, total caloric intake, alcohol consumption, body mass index, menopause status, the use of hormonal replacement, the use of diuretics, history of high blood pressure, total vitamin C intake, and the daily intake of meats, seafood, dairy products, and coffee.

During the 22 years examined, researchers noted 778 confirmed cases of gout. They also noted that increasing the intake of fructose-rich drinks was independently associated with increasing a woman’s risk of gout.

When the participants in the study who consumed one serving of sugar-sweetened soft drinks a day were compared to those who had less than one serving per month, they were found to have a 1.7-fold increased risk of gout. Those who consumed two or more servings per day were at a 2.4-fold increased risk.

Researchers also made these comparisons for those who drink orange juice, a common source for naturally-occurring fructose. Participants who consumed one serving of orange juice a day were at a 1.4-fold increased risk of gout and those who consumed two or more servings per day were at a 2.4-fold increased risk.

When looking at diet soft drinks, researchers found no association with an increased risk in gout.

“From a public health viewpoint, we are particularly concerned about sugar-sweetened sodas, whose consumption has grown so much over the past few decades. It is possible that this increased consumption has contributed in part to the doubling frequency of gout in our society during the same period,” explains Hyon Choi, MD, a rheumatologist at the University of British Columbia and lead investigator in the study. “Our findings indicate that the link between fructose-rich beverages and the risk of gout is comparable to alcoholic beverages, which are well-known causes of gout. Physicians and patients should be aware of this link, as the current lifestyle recommendations for gout prevention almost exclusively focus on reducing purine and alcohol.”

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Editor’s Notes: Hyon Choi, MD will present this research during the ACR Annual Scientific Meeting at the Georgia World Congress Center from 9:00 – 11:00 AM on Wednesday, November 10 outside of Halls B1 & B2. Dr. Choi will be available for media questions and briefing at 8:30 AM on Wednesday, November 10 in the on-site press conference room, B 212

Presentation Number:L5
Fructose-Rich Beverages and the Risk of Gout in Women – A Prospective Study.

Hyon Choi (Boston University School of Medicine)
Walter Willett (Harvard Medical School)
Gary Curhan (Harvard Medical School)

Purpose: Fructose-rich beverages such as sugar-sweetened soda and orange juice may increase serum uric acid and the risk of gout, but prospective data are limited and no data exist for women in particular. The doubling of the prevalence and incidence of gout in the US over the last few decades has coincided with a substantial increase in soft drink and fructose consumption. Our objective was to examine the relation between intake of fructose-rich beverages and fructose and the risk of incident gout in a large prospective cohort of women.

Methods: We prospectively examined over a 22-year period (1984-2006) the relation between intake of sugar-sweetened soft drinks and fructose and the risk of incident gout in 78,906 female participants in the Nurses’ Health Study. We used a supplementary questionnaire to ascertain the ACR survey criteria for gout. We performed Cox proportional hazards modeling to estimate the relative risk (RR) for incident gout after adjusting for the following variables in a time-varying manner: age, total energy intake, alcohol, body-mass index, menopause status, use of hormonal replacement, use of diuretics, history of hypertension, and daily mean intake of meats, seafood, dairy foods, coffee, and total vitamin C.

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 <1 serving/month, the multivariate relative risk of gout was 1.74 (95% confidence interval [CI], 1.19 to 2.25) for 1 serving/day and 2.39 (1.34 to 4.26) for ≥2 serving/day (P for trend<0.001). The corresponding RRs for orange juice were 1.41 (95% CI, 1.03 to 1.93) and 2.42 (95% CI, 1.27 to 4.63) (P for trend=0.02). Diet soft drinks were not associated with the risk of gout (P for trend=0.27). 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 to 2.19) (P for trend=0.004).

View the full abstract at http://www.rheumatology.org/annual.

We also conducted stratified analyses to evaluate whether the association between sweetened soft drink and fructose consumption and the risk of gout varied according to body mass index (<30 vs ≥30 kg/m2), alcohol use (yes vs no), and low-fat dairy intake (≤0.57 servings/day [median value] vs >0.57 servings/day). Relative risks from these stratified analyses consistently suggested associations similar to those from main analyses, and there was no significant interaction with these variables (all P values for interaction >0.63)

Conclusion: Our findings provide prospective evidence that consumption of sugar-sweetened sodas, orange juice, and fructose is associated with an increased risk of incident gout among women. In contrast, diet soda intake is not associated with the risk of gout. Physicians should be aware of the impact of these beverages on the risk of gout.

Disclosure: Hyon Choi, Takeda Pharmaceuticals North America: Research grants, Consulting fees; Walter Willett, nothing to disclose; Gary Curhan, TAP Pharmaceuticals Inc.: Consulting fees.

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Source:  American College of Rheumatology (ACR)