Participants could choose from nine frequency responses (never, 1-3 a month, 1 a week, 2-4 a week, 5-6 a week, 1 a day, 2-3 a day, 4-5 a day, and ≥6 a day). We summed the intake of single items to create a total for consumption of sugar sweetened soft drinks, diet soft drinks, and fruit juice. We also assessed different types of fruits and fruit juices. On all questionnaires participants were asked how often on average during the previous year they had consumed sugar sweetened soft drinks (“Coke, Pepsi, or other cola with sugar,” “caffeine-free Coke, Pepsi, or other cola with sugar,” and “other carbonated beverages with sugar”) and diet soft drinks (“low-calorie cola with caffeine,” “low-calorie caffeine-free cola,” and “other low-calorie beverages”). 2 22 23 The baseline dietary questionnaire was completed in 1986 and was updated every four years. To assess dietary intake including that of soft drinks we used a validated food frequency questionnaire that inquired about the average use of more than 130 foods and beverages during the previous year. We prospectively evaluated the relation between intake of sugar sweetened soft drinks and fructose and the incidence of gout in a cohort of 46 393 men with no history of gout. 17 It is unknown, however, if this acute effect is sustained on a long term basis and eventually translates into an increased risk of gout. 20 21 This urate raising effect was found to be exaggerated in people with hyperuricaemia 18 or a history of gout. 12 16 17 18 19 In humans, acute oral or intravenous administration of fructose results in a rapid increase in serum levels of uric acid through accentuated degradation of purine nucleotides 16 and increased purine synthesis. 14 15 Although such soft drinks contain low levels of purine they contain large amounts of fructose, which is the only carbohydrate known to increase uric acid levels. 13Ĭonventional dietary recommendations for gout have focused on restriction of purine and alcohol intake but with no restriction of sugar sweetened soft drinks. 7 8 Fructose consumption has also increased dramatically since the introduction of commercially produced high fructose corn syrup in 1967, 9 and its yearly per capita use has increased from 0 kg to 29 kg, 10 11 12 whereas naturally occurring fructose consumption has remained relatively stable. 7 For example, soft drink consumption in the US increased by 61% in adults from 1977 to 1997, 7 and sugar sweetened soft drinks represent the largest single food source of calories in the US diet. 4 The doubling of the prevalence 5 and incidence 6 of gout over the past few decades in the United States 3 4 coincided with a substantial increase in the consumption of soft drinks and fructose. 3 Identifying the risk factors that are modifiable with available measures is an important first step in the prevention and management of this painful condition. 1 2 The overall burden from this disease remains substantial and is growing. Gout is the most common inflammatory arthritis in men. Diet soft drinks were not associated with the risk of gout. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Other major contributors to fructose intake such as total fruit juice or fructose rich fruits (apples and oranges) were also associated with a higher risk of gout (P values for trend <0.05).Ĭonclusions Prospective data suggest that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men. The multivariate relative risk of gout according to increasing fifths of fructose intake were 1.00, 1.29, 1.41, 1.84, and 2.02 (1.49 to 2.75 P for trend <0.001). Diet soft drinks were not associated with risk of gout (P for trend=0.99). Compared with consumption of less than one serving of sugar sweetened soft drinks a month the multivariate relative risk of gout for 5-6 servings a week was 1.29 (95% confidence interval 1.00 to 1.68), for one serving a day was 1.45 (1.02 to 2.08), and for two or more servings a day was 1.85 (1.08 to 3.16 P for trend=0.002). Increasing intake of sugar sweetened soft drinks was associated with an increasing risk of gout. Results During the 12 years of follow-up 755 confirmed incident cases of gout were reported. Main outcome measure Incident cases of gout meeting the American College of Rheumatology survey criteria for gout. Participants 46 393 men with no history of gout at baseline who provided information on intake of soft drinks and fructose through validated food frequency questionnaires. Setting Health professionals follow-up study. Objective To examine the relation between intake of sugar sweetened soft drinks and fructose and the risk of incident gout in men.

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