Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies

Abstract

BackgroundThe prevalence of hyperuricemia and gout has increased in recent decades. The role of dietary fructose in the development of these conditions remains unclear.ObjectiveTo conduct a systematic review and meta-analysis of prospective cohort studies investigating the association fructose consumption with incident gout and hyperuricemia.DesignMEDLINE, EMBASE and the Cochrane Library were searched (through September 2015). We included prospective cohort studies that assessed fructose consumption and incident gout or hyperuricemia. 2 independent reviewers extracted relevant data and assessed study quality using the Newcastle-Ottawa Scale. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Results2 studies involving 125 299 participants and 1533 cases of incident gout assessed the association between fructose consumption and incident gout over an average of 17 years of follow-up. No eligible studies assessed incident hyperuricemia as an outcome. Fructose consumption was associated with an increase in the risk of gout (RR=1.62, 95% CI 1.28 to 2.03, p<0.0001) with no evidence of interstudy heterogeneity (I2=0%, p=0.33) when comparing the highest (>11.8% to >11.9% total energy) and lowest (<6.9% to <7.5% total energy) quantiles of consumption.LimitationsDespite a dose–response gradient, the overall quality of evidence as assessed by GRADE was low, due to indirectness. There were only two prospective cohort studies involving predominantly white health professionals that assessed incident gout, and none assessed hyperuricemia.ConclusionsFructose consumption was associated with an increased risk of developing gout in predominantly white health professionals. More prospective studies are necessary to understand better the role of fructose and its food sources in the development of gout and hyperuricemia.Protocol registration numberNCT01608620.

Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies

“…[34][35][36][37][38][39] It is also difficult to reconcile with our earlier systematic review and meta-analysis showing a positive association between fructose intake and gout, 9 given the emerging links between uric acid and diabetes. 37 One possible explanation for the lack of agreement is residual confounding from reverse causality.…”

“…8 Owing to concerns regarding the use of cut-off scores, 6 we did not use our prespecified cut-off score for NOS. 9 Differences were reconciled by consensus.…”

Fructose metabolism and metabolic disease

“…Increased circulating uric acid levels increase the risk of gout, a condition characterized by painful inflammation due to deposition of uric acid crystals in joints. Indeed, a growing body of evidence implicates sugar intake as a risk factor for gout (75). Moreover, elevated serum uric acid levels and gout are associated with other cardiometabolic risk factors in diverse populations (76)(77)(78).…”

Újdonságok köszvényben: patogenezis, társbetegségek, diagnosztika és terápia

“…A fruktóz az egyetlen szénhidrát, mely a purinnukleotid-lebontás és a purinszintézis fokozása révén emeli a húgysavszintet. A fruktóz fokozott beviteléért döntően a cukrozott szénsavas üdítőitalok a felelősek [6,25].…”

“…Diétás és életmódi ajánlás köszvényben [ [25]. Az egyes ételekre és italokra vonatkozó adatok részletes elemzése helyett utalunk néhány hazai [1,2,6,16,31] és nemzetközi összefoglalóra [29,32,33].…”