Article Text

Download PDFPDF

Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies
  1. Sabrina Ayoub-Charette1,2,
  2. Qi Liu1,2,
  3. Tauseef A Khan1,2,
  4. Fei Au-Yeung1,2,
  5. Sonia Blanco Mejia1,
  6. Russell J de Souza1,2,3,
  7. Thomas MS Wolever1,2,4,
  8. Lawrence A Leiter1,2,4,5,
  9. Cyril Kendall1,2,
  10. John L Sievenpiper1,2,4,5
  1. 1 Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
  2. 2 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Health Research Methods, Evidence, and Impact, McMaster University, Toronto, Ontario, Canada
  4. 4 Division of Endocrinology and Metabolism, St. Michael’s Hospital, Toronto, Ontario, Canada
  5. 5 Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr John L Sievenpiper; john.sievenpiper{at}


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.

  • uric acid
  • systematic review and meta-analysis
  • gout
  • sugars
  • fructose
  • food sources of fructose containing sugars

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors had full access to all of the data (including statistical reports and tables) in this study and take full responsibility for the integrity of the data and the accuracy of the data analysis. Conception and design: JLS. Analysis and interpretation of the data: all authors. Drafting of the article: SA-C, QL, TAK, JLS. Critical revision of the article for important intellectual content: all authors. Final approval of the article: all authors. Statistical expertise: TAK and RJdS. Obtaining of funding: JLS. Administrative, technical or logistic support: SBM. Collection and assembly of data: QL, SA-C and FA-Y. Guarantor: JLS.

  • Funding This work was funded by the Canadian Institutes of Health Research (funding reference number, 129920). The Diet, Digestive tract, and Disease (3-D) Centre, funded through the Canada Foundation for Innovation and the Ministry of Research and Innovation’s Ontario Research Fund, provided the infrastructure for the conduct of this project. JLS was funded by a PSI Graham Farquharson Knowledge Translation Fellowship, Canadian Diabetes Association (CDA) Clinician Scientist award, Canadian Institutes of Health Research (CIHR) Institute of Nutrition, Metabolism and Diabetes (INMD)/Canadian Nutrition Society (CNS) New Investigator Partnership Prize and Banting & Best Diabetes Centre Sun Life Financial New Investigator Award. None of the sponsors had a role in any aspect of the present study, including design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, approval of the manuscript or decision to publish.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There is no additional unpublished data available.

  • Patient consent for publication Not required.