Journal List > J Rheum Dis > v.23(5) > 1064282

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

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.

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Figure 1.
Flow chart for the study selection.
jrd-23-304f1.tif
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.
jrd-23-304f2.tif
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.
jrd-23-304f3.tif
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
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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