Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies

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metabolic syndrome 1 endocrinologydiseases
hyperinsulinemia 1 endocrinologydiseases
hyperuricemia 38 endocrinologydiseases

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hyperinsulinemia 24965 overproduction of uric acid in the presence of additional fructose. Additionally, fructose-induced hyperinsulinemia and insulin resistance[39][58] may lead to higher levels of circulating uric acid through the reduction
hyperuricemia 52 Title: BMJ OpenFructose intake and risk of gout and hyperuricemia : a systematic review and meta-analysis of prospective cohort studiesJoseph JamnikSara RehmanSonia Blanco
hyperuricemia 740 SaskatchewanPublication date (collection): /2016Publication date (epub): 10/2016AbstractBackgroundThe prevalence of hyperuricemia and gout has increased in recent decades. The role of dietary fructose in the development of these conditions
hyperuricemia 1042 prospective cohort studies investigating the association fructose consumption with incident gout and hyperuricemia .DesignMEDLINE, EMBASE and the Cochrane Library were searched (through September 2015). We included prospective
hyperuricemia 1238 2015). We included prospective cohort studies that assessed fructose consumption and incident gout or hyperuricemia . 2 independent reviewers extracted relevant data and assessed study quality using the Newcastle-Ottawa
hyperuricemia 1926 and incident gout over an average of 17 years of follow-up. No eligible studies assessed incident hyperuricemia as an outcome. Fructose consumption was associated with an increase in the risk of gout (RR=1.62, 95%
hyperuricemia 2530 studies involving predominantly white health professionals that assessed incident gout, and none assessed hyperuricemia .ConclusionsFructose consumption was associated with an increased risk of developing gout in predominantly
hyperuricemia 2811 necessary to understand better the role of fructose and its food sources in the development of gout and hyperuricemia .Protocol registration numberNCT01608620.Strengths and limitations of this studyThis systematic review
hyperuricemia 3980 major risk factor for gout and plays a major role in the pathogenesis of this condition.[2] Chronic hyperuricemia and gout also represent potential risk factors for cardiovascular disease (CVD).[3] According to the
hyperuricemia 4159 disease (CVD).[3] According to the National Health and Nutritional Examination Survey 2007–2008, hyperuricemia affects >20% of the US population, while ∼4% of American adults have gout.[4] The prevalence of hyperuricemia
hyperuricemia 4271 hyperuricemia affects >20% of the US population, while ∼4% of American adults have gout.[4] The prevalence of hyperuricemia and gout has increased in recent decades,[4] suggesting potential environmental triggers. Several lifestyle
hyperuricemia 4670 meat and seafood.[9][10] Recent research has also implicated fructose intake in the pathogenesis of hyperuricemia and gout.[11][12]Fructose is a monosaccharide found commonly in plants. It is also a major constituent
hyperuricemia 4927 sugar-sweetened beverages (SSBs).[13] Ecological evidence has shown that the increasing prevalence of hyperuricemia and gout in developed countries has paralleled the increase in consumption of total fructose and HFCS.[14]
hyperuricemia 5611 and serum uric acid.[19] The role of fructose from all dietary sources as a risk factor for incident hyperuricemia and ultimately gout, therefore, remains unclear. Furthermore, there is a notable lack of meta-analyses
hyperuricemia 6030 prospective cohort studies investigating total fructose consumption and its association with incident hyperuricemia and gout.MethodsThis meta-analysis was conducted in accordance with the Cochrane handbook for systematic
hyperuricemia 6624 terms were used: ‘fructose’, ‘sucrose’, ‘sugar’, ‘honey’, ‘HFCS’, ‘gout’, ‘ hyperuricemia ’ and ‘uric acid’. No language restrictions were imposed on the search. The complete search strategy
hyperuricemia 7081 prospective cohort studies which assessed the association between total dietary fructose intake and incident hyperuricemia or gout. Studies were considered eligible if cases of gout were ascertained using self-report of a physician
hyperuricemia 7239 cases of gout were ascertained using self-report of a physician diagnosis, while the assessment of hyperuricemia required serum uric acid measurements above study-specific predefined thresholds.10.1136/bmjopen-2016-013191.supp1supplementary
hyperuricemia 7866 characteristics, duration of follow-up, method of dietary assessment, fructose exposure levels, number of incident hyperuricemia /gout cases, covariates included in statistical models and risk ratios (RRs) of hyperuricemia or gout
hyperuricemia 7959 incident hyperuricemia/gout cases, covariates included in statistical models and risk ratios (RRs) of hyperuricemia or gout per quantile of fructose intake with 95% CIs.Study qualityStudy quality was assessed using the
hyperuricemia 10068 Cochrane Centre, The Cochrane Collaboration). RRs of extreme quantiles of fructose intake for incident hyperuricemia /gout were natural-log transformed and pooled using the generic inverse variance method.[36] Although
hyperuricemia 11503 identify any prospective studies that assessed total fructose intake and its association with incident hyperuricemia .Figure 1Summary of evidence search and selection. Flow of the literature search for the effect of fructose
hyperuricemia 11653 and selection. Flow of the literature search for the effect of fructose intake on incident gout and hyperuricemia . Of the 2195 studies initially identified, 2171 were excluded on the basis of title and abstract review.
hyperuricemia 17714 heterogeneity). All results are presented as risk ratios (RR) with 95% CIs.Total fructose intake on incident hyperuricemia The lack of prospective studies investigating the association between total fructose intake and incident
hyperuricemia 17832 lack of prospective studies investigating the association between total fructose intake and incident hyperuricemia yielded by our strategy precluded testing the effect of total fructose intake on incident hyperuricemia.Study
hyperuricemia 17936 hyperuricemia yielded by our strategy precluded testing the effect of total fructose intake on incident hyperuricemia .Study qualityOnline supplementary table S2 shows the NOS for assessing the quality of cohort studies.
hyperuricemia 18713 prospective cohort studies investigating the association between total fructose intake and risk of developing hyperuricemia and gout. We identified a total of two prospective studies that assessed the relationship between fructose
hyperuricemia 18905 relationship between fructose and gout[38][39] and no prospective studies pertaining to fructose and hyperuricemia . The two studies that assessed gout included a total of 125 299 participants free of gout at baseline,
hyperuricemia 20321 notable limitations. We were unable to test the pooled relationship between fructose intake and incident hyperuricemia due to the lack of any prospective studies investigating this association. With regard to fructose and
hyperuricemia 23206 gout and is understood to be instrumental in its development.[1] Emerging evidence has also implicated hyperuricemia in the development of the metabolic syndrome, hypertension and CVD[3] although these associations have
hyperuricemia 23506 individuals without gout.[49][50] We found no prospective studies investigating fructose intake and incident hyperuricemia to support the observed association between fructose and gout. Some cross-sectional analyses and clinical
hyperuricemia 23858 however, analysis of NHANES data did not support the link between fructose intake and increased risk of hyperuricemia .[55] Furthermore, prospective evidence has shown that intake of SSBs, which is known to be a large contributor
hyperuricemia 24089 total fructose intake in western populations,[56] is not associated with an increased risk of incident hyperuricemia .[52] These inconsistent findings highlight the need for more long-term prospective studies investigating
hyperuricemia 24326 from all sources in order to gain a better understanding of the effects of fructose intake on risk of hyperuricemia .Meaning of study: possible explanations and implications for clinicians and policymakersMechanistically,
hyperuricemia 25279 act as a risk factor for the development of gout; however, the lack of prospective studies assessing hyperuricemia as an outcome limits our ability to attribute this association with gout to the mechanism proposed above.
hyperuricemia 26564 fructose (SSBs, fruits and fruit products, grain-based products, dairy products, etc) on incident gout and hyperuricemia are necessary to better inform policymakers as they develop improved dietary guidelines for the management
hyperuricemia 27531 identify any prospective studies investigating the effects of fructose intake on risk of developing hyperuricemia . Given that gout is on the rise and has recently been shown to affect ∼4% of the American population,[4][5]
hyperuricemia 27905 more prospective studies assess the intake of fructose and its food sources in relation to gout and hyperuricemia in diverse populations to determine if and, ultimately, to what extent fructose may mediate the risk
hyperuricemia 28023 diverse populations to determine if and, ultimately, to what extent fructose may mediate the risk of hyperuricemia and gout
metabolic syndrome 23246 in its development.[1] Emerging evidence has also implicated hyperuricemia in the development of the metabolic syndrome , hypertension and CVD[3] although these associations have not been consistently reported in studies

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