Such Sweet Sorrow: Fructose and the Incidence of Gout

Abstract

Gout is presently the most common inflammatory arthritis in the United States (>3 million reported cases in 2005) [1], and epidemiologic studies indicate that its prevalence has risen as much as fourfold in the past few decades. A better understanding of the reasons for this increase and the identification of modifiable risk factors is important to reduce gout incidence and manage established cases. Recently, data from animal and physiologic studies have suggested that fructose may have a unique capacity to induce hyperuricemia, the necessary predecessor to the onset of gout [2–4]. Specifically, consumption of fructose results in rapid rises in serum urate, and biochemical studies indicate that the metabolism of fructose, in contrast to that of other sugars, results in the conversion of adenosine triphosphate to adenosine diphosphate, which provides precursor purines for the urate synthetic pathway. Moreover, per capita fructose consumption, in the form of sweetened soft drinks and foods supplemented with high fructose corn syrup, has risen in parallel with the current wave of gout. Indeed, recent studies indicate that sweetened soft drinks have become the single largest calorie source in the American diet [5]. However, actual clinical data linking fructose intake with gout incidence are sparse. This article discusses a study by Choi and Curhan that employed a large prospective cohort of male health professionals to assess the role of fructose consumption, and more specifically, the consumption of sweetened soft drinks, on the risk of gout.