Intended for healthcare professionals


Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study

BMJ 2008; 336 doi: (Published 07 February 2008) Cite this as: BMJ 2008;336:309
  1. Hyon K Choi, associate professor of medicine1,
  2. Gary Curhan, associate professor of medicine2
  1. 1Arthritis Research Centre of Canada, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1L7, Canada
  2. 2Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  1. Correspondence to: H K Choi hchoi{at}
  • Accepted 3 November 2007


Objective To examine the relation between intake of sugar sweetened soft drinks and fructose and the risk of incident gout in men.

Design Prospective cohort over 12 years.

Setting Health professionals follow-up study.

Participants 46 393 men with no history of gout at baseline who provided information on intake of soft drinks and fructose through validated food frequency questionnaires.

Main outcome measure Incident cases of gout meeting the American College of Rheumatology survey criteria for gout.

Results During the 12 years of follow-up 755 confirmed incident cases of gout were reported. Increasing intake of sugar sweetened soft drinks was associated with an increasing risk of gout. Compared with consumption of less than one serving of sugar sweetened soft drinks a month the multivariate relative risk of gout for 5-6 servings a week was 1.29 (95% confidence interval 1.00 to 1.68), for one serving a day was 1.45 (1.02 to 2.08), and for two or more servings a day was 1.85 (1.08 to 3.16; P for trend=0.002). Diet soft drinks were not associated with risk of gout (P for trend=0.99). The multivariate relative risk of gout according to increasing fifths of fructose intake were 1.00, 1.29, 1.41, 1.84, and 2.02 (1.49 to 2.75; P for trend <0.001). Other major contributors to fructose intake such as total fruit juice or fructose rich fruits (apples and oranges) were also associated with a higher risk of gout (P values for trend <0.05).

Conclusions Prospective data suggest that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Diet soft drinks were not associated with the risk of gout.


  • We thank Walter Willett for his critical review of the manuscript.

  • Contributors: Both authors conceived, designed, and carried out the study, analysed the data, and critically reviewed the paper and approved the final draft for publication. HKC drafted the manuscript and is guarantor.

  • Funding: This work was supported in part by grants from the National Institutes of Health (DK58573, AA11181, HL35464, and CA55075) and TAP Pharmaceuticals. The funding sources had no role in the design, conduct, or reporting of the study or in the decision to submit the manuscript for publication. HKC is the Mary Pack Arthritis Society of Canada chair in rheumatology.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the Partners Health Care System institutional review board; return of a completed questionnaire was accepted by the board as implied informed consent.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 3 November 2007
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