Study Links Fructose-Rich Beverages with Increased Risk of Gout in Women

"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."

11 Nov 2010 --- Consumption of fructose-rich beverages, such as sugar-sweetened sodas and orange juice is associated with an increased risk of gout among women, although their contribution to the risk of gout in the population is likely modest because of the low incidence rate among women, according to a study that will appear in the November 24 print edition of JAMA. The study is being released early online to coincide with its presentation at the American College of Rheumatology annual scientific meeting.

Gout is a common and very painful inflammatory arthritis. "The increasing disease burden of gout in the United States over the last few decades (e.g., an annual incidence of 16/100,000 in 1977 vs. 42/100,000 in 1996) coincided with a substantial increase in soft drink and fructose consumption," the authors write. "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."

Hyon K. Choi, M.D., Dr.P.H., of the Boston University School of Medicine, and colleagues examined the relationship between intake of fructose-rich beverages and fructose and incidence of gout in a large group of women. The study consisted of data from the Nurses' Health Study, a U.S. prospective cohort study spanning 22 years (1984-2006). The researchers analyzed data from 78,906 women with no history of gout at the beginning of the study and who provided information on intake of beverages and fructose through validated food frequency questionnaires.

During 22 years of follow-up, the researchers documented 778 newly diagnosed cases meeting American College of Rheumatology survey criteria for gout. They found that increasing intake of sugar-sweetened soda was associated with increasing risk of gout. Compared with consumption of less than 1 serving per month, women who consumed one serving per day had a 74 percent increased risk of gout; and those with 2 or more servings per day had a 2.4 times higher risk. Diet soft drinks were not associated with the risk of gout.

Orange juice intake was also associated with risk of gout. Compared with women who consumed less than a glass (6 oz.) of orange juice per month, women who consumed 1 serving per day had a 41 percent higher risk of gout, and there was a 2.4 times higher risk with 2 or more servings per day. Also, compared with women in the lowest quintile (fifth) of free fructose intake, women in the highest quintile had a 62 percent higher risk of gout.

The authors note that although the relative risks of gout associated with fructose-rich beverages among women were substantial, the corresponding absolute risk differences were modest given the low incidence rate of gout among women.

The researchers add that their findings have practical implications for the prevention of gout in women, and that physicians should be aware of the potential effect of these beverages on the risk of gout. "Our data provide prospective evidence that fructose poses an increased risk of gout among women, thus supporting the importance of reducing fructose intake."

In response to "Fructose-Rich Beverages and Risk of Gout in Women," a study published online today in the Journal of the American Medical Association, Dr. Richard Adamson, former director, Division of Cancer Etiology and scientific director, National Cancer Institute of the National Institutes of Health; former vice president of Scientific and Technical Affairs for the American Beverage Association; current president of TPN Associates, LLC, and consultant to the American Beverage Association, said: "This study fails to be meaningful when it comes to informing Americans about the real causes of gout. In fact, suggesting that fructose intake causes gout is not based on modern day science, but rather centuries-old theory. In reality, the compendium of research conducted on gout shows foods and beverages high in purines - such as alcohol, beer and certain meats - are strongly linked to uric acid metabolism, and therefore gout. As the authors themselves note, neither soft drinks nor orange juice - the beverages discussed in this study - contain purines.

Moreover, it is misleading to label these beverages as ‘fructose-rich' given that at least 45 percent, and possibly as much as 58 percent, of the sweeteners they contain are in fact glucose, not fructose. Even so, for the authors to reference the effects of fructose infusion as compared to oral intake of a sweetened beverage is like comparing apples to oranges. The physiological effects of injecting something versus ingesting it are worlds apart. Furthermore, the authors also suggest that consuming fruit juices, but not eating whole fruit, would lead to increased risk for gout. Yet, the percentage of fructose content in both fruit and fruit juice are identical. This clearly suggests that it is not the fructose content that is leading to the increased risk for gout.

Equally as important, the authors of this paper look at association, not causation. They also note that the contribution, if any, of these ‘fructose-rich' beverages to incidence of gout is ‘likely modest given the low incidence rate among women.'

The fact remains that the strongest risk factor for developing gout is family history - if your mom or your dad has gout, you are at a greater risk of developing it. Those who have a family history of gout, or are interested in learning the facts about this arthritic condition, should visit the website of the National Institutes of Health National Institute for Arthritis and Musculoskeletal and Skin Diseases."