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Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies.
BMJ Open. 2019 05 05; 9(5):e024171.BO

Abstract

OBJECTIVE

Sugar-sweetened beverages (SSBs) are associated with hyperuricaemia and gout. Whether other important food sources of fructose-containing sugars share this association is unclear.

DESIGN

To assess the relation of important food sources of fructose-containing sugars with incident gout and hyperuricaemia, we conducted a systematic review and meta-analysis of prospective cohort studies.

METHODS

We searched MEDLINE, Embase and the Cochrane Library (through 13 September 2017). We included prospective cohort studies that investigated the relationship between food sources of sugar and incident gout or hyperuricaemia. Two independent reviewers extracted relevant data and assessed the risk of bias. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method with random effects model and expressed as RR with 95% confidence intervals (CIs). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.

RESULTS

We identified three studies (1 54 289 participants, 1761 cases of gout), comparing the highest with the lowest level of exposure for SSBs, fruit juices and fruits. No reports were found reporting incident hyperuricaemia. Fruit juice and SSB intake showed an adverse association (fruit juice: RR=1.77, 95% CI 1.20 to 2.61; SSB: RR=2.08, 95% CI 1.40 to 3.08), when comparing the highest to lowest intake of the most adjusted models. There was no significant association between fruit intake and gout (RR 0.85, 95% CI 0.63 to 1.14). The strongest evidence was for the adverse association with SSB intake (moderate certainty), and the weakest evidence was for the adverse association with fruit juice intake (very low certainty) and lack of association with fruit intake (very low certainty).

CONCLUSION

There is an adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit intake. Further research is needed to improve our estimates.

TRIAL REGISTRATION NUMBER

NCT02702375; Results.

Authors+Show Affiliations

Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

31061018

Citation

Ayoub-Charette, Sabrina, et al. "Important Food Sources of Fructose-containing Sugars and Incident Gout: a Systematic Review and Meta-analysis of Prospective Cohort Studies." BMJ Open, vol. 9, no. 5, 2019, pp. e024171.
Ayoub-Charette S, Liu Q, Khan TA, et al. Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies. BMJ Open. 2019;9(5):e024171.
Ayoub-Charette, S., Liu, Q., Khan, T. A., Au-Yeung, F., Blanco Mejia, S., de Souza, R. J., Wolever, T. M., Leiter, L. A., Kendall, C., & Sievenpiper, J. L. (2019). Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies. BMJ Open, 9(5), e024171. https://doi.org/10.1136/bmjopen-2018-024171
Ayoub-Charette S, et al. Important Food Sources of Fructose-containing Sugars and Incident Gout: a Systematic Review and Meta-analysis of Prospective Cohort Studies. BMJ Open. 2019 05 5;9(5):e024171. PubMed PMID: 31061018.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies. AU - Ayoub-Charette,Sabrina, AU - Liu,Qi, AU - Khan,Tauseef A, AU - Au-Yeung,Fei, AU - Blanco Mejia,Sonia, AU - de Souza,Russell J, AU - Wolever,Thomas Ms, AU - Leiter,Lawrence A, AU - Kendall,Cyril, AU - Sievenpiper,John L, Y1 - 2019/05/05/ PY - 2019/5/8/entrez PY - 2019/5/8/pubmed PY - 2020/5/1/medline KW - food sources of fructose containing sugars KW - fructose KW - gout KW - sugars KW - systematic review and meta-analysis KW - uric acid SP - e024171 EP - e024171 JF - BMJ open JO - BMJ Open VL - 9 IS - 5 N2 - OBJECTIVE: Sugar-sweetened beverages (SSBs) are associated with hyperuricaemia and gout. Whether other important food sources of fructose-containing sugars share this association is unclear. DESIGN: To assess the relation of important food sources of fructose-containing sugars with incident gout and hyperuricaemia, we conducted a systematic review and meta-analysis of prospective cohort studies. METHODS: We searched MEDLINE, Embase and the Cochrane Library (through 13 September 2017). We included prospective cohort studies that investigated the relationship between food sources of sugar and incident gout or hyperuricaemia. Two independent reviewers extracted relevant data and assessed the risk of bias. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method with random effects model and expressed as RR with 95% confidence intervals (CIs). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: We identified three studies (1 54 289 participants, 1761 cases of gout), comparing the highest with the lowest level of exposure for SSBs, fruit juices and fruits. No reports were found reporting incident hyperuricaemia. Fruit juice and SSB intake showed an adverse association (fruit juice: RR=1.77, 95% CI 1.20 to 2.61; SSB: RR=2.08, 95% CI 1.40 to 3.08), when comparing the highest to lowest intake of the most adjusted models. There was no significant association between fruit intake and gout (RR 0.85, 95% CI 0.63 to 1.14). The strongest evidence was for the adverse association with SSB intake (moderate certainty), and the weakest evidence was for the adverse association with fruit juice intake (very low certainty) and lack of association with fruit intake (very low certainty). CONCLUSION: There is an adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit intake. Further research is needed to improve our estimates. TRIAL REGISTRATION NUMBER: NCT02702375; Results. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/31061018/Important_food_sources_of_fructose_containing_sugars_and_incident_gout:_a_systematic_review_and_meta_analysis_of_prospective_cohort_studies_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=31061018 DB - PRIME DP - Unbound Medicine ER -