Association between Sugar-Sweetened Beverage Consumption and the Risk of Gout: A Meta-Analysis

Young Ho Lee; Gwan Gyu Song

doi:10.4078/jrd.2016.23.5.304

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Lee and Song: Association between Sugar-Sweetened Beverage Consumption and the Risk of Gout: A Meta-Analysis

Original Article

J Rheum Dis 2016;23(5):304-310.

Published online: 31 October 2016

DOI: https://doi.org/10.4078/jrd.2016.23.5.304

Association between Sugar-Sweetened Beverage Consumption and the Risk of Gout: A Meta-Analysis

Young Ho Lee, Gwan Gyu Song

Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

Corresponding to: Young Ho Lee, Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea. E-mail: lyhcgh@korea.ac.kr

Received 22 August 201620 September 2016 Accepted 21 September 2016

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The aim of this study was to analyze published data for an association between consumption of sugar sweetened beverages (SSBs) and the development of gout.

Methods

We performed a meta-analysis to examine the highest and lowest categories of SSB consumption in relation to risk of gout.

Results

Three studies including 2,606 gout patients among 134,008 participants were included. Meta-analysis revealed a significant association between SSB consumption and gout risk (relative risk [RR]=1.986, 95% confidence interval [CI]=1.447∼2.725, p=2.2×10⁻⁵). Stratification by ethnicity showed a significant association between SSB consumption and gout risk in ethnic Europeans, but not in Polynesians (RR=2.110, 95% CI=1.470∼2.725, p=5.1×10⁻⁵; RR=1.624, 95% CI=0.842∼3.135, p=0.148, respectively). SSB consumption and gout risk were associated in original data and imputed data, for both men and women, regardless of data type and sex. The association between the highest SSB consumption group and gout was stronger than the association between the middle group and gout, indicating a doseresponse gradient (RR=1.986, 95% CI=1.447∼2.725, p<2.2×10⁻⁵ vs. RR=1.260, 95% CI=1.043∼1.522, p<0.016).

Conclusion

This meta-analysis of 134,008 participants demonstrates that SSB consumption is associated with an elevated risk of gout development, particularly in the ethnic European population. Available evidence indicates a doseresponse gradient of the relationship between SSB consumption and gout risk.

Keywords: Sugar-sweetened beverages, Gout, Risk

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Figure 1.

Flow chart for the study selection.

Figure 2.

Meta-analysis of the association between sugar sweetened beverages (SSBs) consumption and gout risk for the highest versus lowest groups of SSBs intake in the overall group (A) and each ethnic group (B). CI: confidence interval.

Figure 3.

Funnel plot of studies that examined the association between sugar sweetened beverages consumption and gout risk (Egger's regression test p-value=0.845). SE: standard error.

Table 1.

Characteristics of the individual studies included in the meta-analysis

Study [Ref]	Country	Ethnicity	Subjects' age (yr), range	Sex (%), male	Study period	Study design	Case (n)	Total (n)	RR (95% CI) for highest vs. lowest intakes	Adjustment for confounders	Study quality
Batt-1, 2014 [7]	USA	Caucasian	23∼94	77.8	2006∼2011	Cross-sectional	412	592	2.38^* (0.64∼8.84), Ptrend=0.020 (>5 servings/d vs. 0)	Age, sex, BMI, alcohol (continuous variable), fruit intake (continuous variable), kidney disease	8
Batt-2, 2014 [7]	USA	Polynesian	23∼81	80.3	2006∼2011	Cross-sectional	190	502	1.44^* (0.59∼3.53), Ptrend = 0.011 (>5 servings/d vs. 0)	Age, sex, BMI, alcohol (continuous variable), fruit intake (continuous variable), kidney disease
Batt-3, 2014 [7]	USA	Polynesian	18∼81	87.9	2006∼2011	Cross-sectional	323	540	2.17^* (0.98∼4.77), Ptrend = 0.050 (>5 servings/d vs. 0)	Age, sex, BMI, alcohol (continuous variable), fruit intake (continuous variable), kidney disease	8
Batt-4, 2014 [7]	USA	Caucasian	45∼65	75.0	ND	Cohort	148	7,075	2.31^* (0.65∼8.19), Ptrend = 0.026 (>5 servings/d vs. 0)	Age, sex, BMI, alcohol (continuous variable), fruit intake (continuous variable), kidney disease, high blood pressure and relatedness	8
Choi, 2010 [8]	USA	Caucasian^†	30∼55	0	1984∼2006	Cohort	778	78,906	1.85 (1.08∼3.16), Ptrend = 0.002 (>2 servings/d vs. 1 </mo)	Age, total energy intake, BMI, menopause status, use of hormonal therapy, diuretic use, history of hypertension, and intake of alcohol, total meats, seafood, dairy products, total vitamin C, SSB, and the beverages	8
Choi, 2008 [9]	Canada	Caucasian ^‡	40∼75	100	1986∼1998	Cohort	755	46,393	2.39 (1.34∼4.26), Ptrend<0.001 (>2 servings/d vs. 1 </mo)	Age, total energy intake, body mass index, diuretic use, history of hypertension, and history of chronic renal failure; intake of alcohol, total meats, seafood, purine rich vegetables, dairy foods, and total vitamin C; and sweetened soft drinks, diet soft drinks, sweetened cola, and other sweetened soft drinks	8

Ref: Reference, RR: relative risk, CI: confidence interval, SSB: sugar-sweetened beverage, ND: not determined, BMI: body mass index.

^* Odds ratio

^† 95%: Caucasian

^‡ 91%: Caucasian.

Table 2.

Meta-analysis of studies on sugar sweetened beverages consumption and risk of gout

Variable	Population	No. of studies	Number		Test of association			Test of heterogeneity
Variable	Population	No. of studies	Case	Total	RR	95% CI	p-value	Model	p-value	I²
All	All	6	2,606	134,008	1.986	1.447∼2.725	2.2×10⁻⁵	F	0.952	0
Ethnicity	Caucasian	4	2,093	132,966	2.110	1.470∼3.028	5.1×10⁻⁵	F	0.934	0
	Polynesian	2	513	1,042	1.624	0.842∼3.135	0.148	F	0.634	0
Study design	Cohort	3	1,981	132,374	2.098	1.441∼3.055	1.1×10⁻⁴	F	0.811	0
	Cross-sectional	3	925	1,634	1.736	0.964∼3.124	0.066	F	0.810	0
Data type	Original	2	1,533	125,299	2.083	1.405∼3.087	2.6×10⁻⁴	F	0.525	0
	Imputed	4	1,073	8,709	1.819	1.067∼3.100	0.028	F	0.906	0
Sex	Male	1	755	46,393	1.850	1.082∼3.164	0.025	NA	NA	NA
	Female	1	778	78,906	2.390	1.340∼4.261	0.003	NA	NA	NA
Dose	Highest	6	2,606	134,008	1.986	1.447∼2.725	2.2×10⁻⁵	F	0.952	0
	Middle	6	2,606	134,008	1.260	1.043∼1.522	0.016	F	0.751	0

RR: relative risk, CI: confidence interval, F: fixed effects model, NA: not available.

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