Consumption of fructose- rich drinks, such as sugar-sweetened sodas and orange juice is associated with an increased risk of gout among women, according to a study published in JAMA – although their contribution to the risk of gout in the population is likely modest due to the low incidence of gout among women.
The research suggests intake of sugar sweetened sodas increases the risk of gout bye up to 2.4 times. The study also finds that the risk of gout was significantly increased with increasing intake of fructose – the main ingredient thought to cause the increased risk in sodas.
“Our findings have practical implications for the prevention of gout in women. As conventional dietary recommendations for gout have focused on restriction of purine intake, low-purine diets are often high in carbohydrates, including fructose-rich foods…Our data provide prospective evidence that fructose poses an increased risk of gout among women, thus supporting the importance of reducing fructose intake,” wrote the researchers, led by Dr Hyon Choi, of the Boston University School of Medicine.
Gout results from an excess of uric acid in the body. Overload of uric acid leads to the formation of urate crystals in bodily tissues, especially the joints – which can lead to recurring attacks of joint inflammation (arthritis).
Dr Choi and colleagues stated that the increasing disease burden of gout over recent decades has coincided with a substantial increase in soft drink and fructose consumption among the general population.
Fructose in beverages is consumed predominantly in one of two forms: sucrose which is composed of 50 percent fructose with 50 percent glucose, or high fructose corn syrup, which is most commonly used in the form 55 percent fructose, 45 percent glucose.
Sugar-sweetened beverages contain low levels of uric acid precursors, but do contain high amounts of fructose – the only carbohydrate known to increase uric acid levels.
"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," stated the authors.
A recent prospective study of men found that sugar-sweetened sodas, fruit juices, and fructose were associated with a substantially increased risk of gout among men (BMJ – doi:10.1136/bmj.39449.819271.BE ).
The researchers noted that previous research has suggested that the effects of fructose on uric acid, and thus the risk of gout may be weaker in women, in whom the incidence of gout is substantially lower than men. However to date, no other cohort study has investigated this relationship.
Using data from the Nurses’ Health Study, the researchers analysed data from nearly 80,000 women.
Dr Choi and co workers observed increasing fructose intake to be associated with an increased risk of gout.
Compared with consumption of less than one serving per month, women who consumed one serving per day had a 74 percent increased risk of gout; and those with two or more servings per day had a 2.4 times higher risk. Diet soft drinks were not associated with the risk of gout.
Intake of orange juice was also associated with increased risk of gout. The researchers found that women consumer one serving of orange juice per day had a 41 per cent higher risk of gout than those who consumed less than a glass per month.
Choi and colleagues stated that the increases in risk were likely due to increasing levels of uric acid production; however they added that fructose may also indirectly increase the risk of gout by increasing insulin resistance and circulating insulin levels.
The authors concluded that their findings provide the first prospective evidence to suggest that fructose and fructose-rich beverages are important risk factors to be considered in the primary prevention of gout among women. However, they noted that due to the relatively low incidence of gout among women in the population, the contribution of such beverages to an increased risk is likely to be modest.
Published online ahead of print, doi: 10.1001/jama.2010.1638
“Fructose-Rich Beverages and Risk of Gout in Women”
Authors: H.K. Choi, W. Willett, G. Curhan