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Introduction
Gout is the most common inflammatory arthritis in men. 1 2 The overall burden from this disease remains substantial and is growing. 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. 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. 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. 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. 13
Conventional dietary recommendations for gout have focused on restriction of purine and alcohol intake but with no restriction of sugar sweetened soft drinks. 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. 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. 20 21 This urate raising effect was found to be exaggerated in people with hyperuricaemia 18 or a 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. We prospectively evaluated the relation between intake of sugar sweetened soft drinks and fructose and the incidence of gout in a cohort of 46â[euro][per thousand]393 men with no history of gout.
Methods
The health professionals follow-up study is an ongoing longitudinal study of 51â[euro][per thousand]529 male dentists, optometrists, osteopaths, pharmacists, podiatrists, and veterinarians. The men are predominantly white (91%) and were aged 40 to 75 years in 1986. The participants returned a mailed questionnaire...