Meta-analysisindependent cross-checkabstract checked I-SUG-109 standard review
Sugary drinks and juice linked to gout
Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies.
Overview
Ayoub-Charette S et al.. BMJ Open 2019 · PMID 31061018 · DOI 10.1136/bmjopen-2018-024171
Pooled data from three large cohorts linked high sugary-drink intake with about twice the gout risk; fruit juice was also linked, but whole fruit was not.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Assess which sugar sources are linked to gout.
- How was the study done?
Pooled three prospective cohorts.
- How many people, animals or samples were studied?
154,289 participants, 1761 gout cases.
- What was actually found?
Sugary drinks RR 2.08; juice 1.77; fruit no association.
- How large was the observed effect?
RR 2.08 (1.40-3.08).
- What do the results mean in everyday life?
People at risk of gout benefit from limiting sugary drinks and juices.
- What are the study's limitations?
Only three studies, mostly US professionals.
- What does it say about Elawady's specific claim?
Supports 'double the risk' for sugary drinks; shows juice is not exempt.
- Do the results apply to Germany and Europe?
Transferability moderate.
- What can explicitly not be concluded from this study?
Cannot prove causation.
Scientific in-depth review
1. Full reference
- Authors
- Ayoub-Charette S et al.
- Journal
- BMJ Open
- Year
- 2019
- Identifier
- PMID 31061018 DOI 10.1136/bmjopen-2018-024171
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Funded by CIHR (PubMed grant list); author disclosures not reviewed
2. Research question
Are food sources of fructose-containing sugars (SSB, fruit juice, fruit) associated with incident gout?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of prospective cohorts (MEDLINE, Embase, Cochrane to September 2017), GRADE
- Population
Adults in prospective cohorts (mostly US health professionals)
- Country
USA
- Period
to 13 September 2017
- Sample size
3 studies; 154,289 participants; 1761 gout cases
- Inclusion and exclusion criteria
Prospective cohorts on food sources of sugar and gout or hyperuricaemia
4. Methods and endpoints
- Exposure / intervention
SSB, fruit juice, fruit (highest vs lowest)
- Comparator
Lowest intake
- Endpoints
Incident gout
- Statistical methods
Random-effects pooling of log RR; GRADE
5. Actual results
- Results
SSB RR 2.08 (95% CI 1.40-3.08; moderate certainty); fruit juice RR 1.77 (1.20-2.61; very low certainty); fruit RR 0.85 (0.63-1.14; very low certainty).
- Absolute risks
not reported
- Authors' conclusion
Adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit.
6. Strengths
- GRADE assessment
- Source-specific analysis
7. Weaknesses
- Only three cohorts
- Overlap with Choi 2008 (A-SOD-06)
- Mostly white US health professionals
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Few studies; overlapping populations.
9. Assessment of the statistical interpretation
CI log-symmetric (stats/C-SOD-05_gout.py). Includes the Choi 2008 cohort, so it is not independent confirmation of A-SOD-06.
10. Relevance to the specific claim
Supports C-SOD-05 ('double' is close to the pooled RR 2.08) and contradicts C-SUG-06 (fruit juice also associated with gout).
11. Independent contrary findings
Lu 2025 (not added) found smaller pooled ORs across 22 observational studies (SSB-gout OR 1.21).
12. Transferability to Germany and Europe
Moderate; US populations.
13. Overall methodological judgement
Supports an SSB-gout association of roughly double at the highest intakes in these cohorts, and a similar but less certain signal for juice.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Data from women, non-white and non-US populations.
15. Linked fact checks
- Two sugary sodas a day double the risk of gout in men. – Studies supporting the claim
- Implicit in the system's lists: sugar-cane juice, canned juices, honey, jam and sweets are acceptable while sugar-sweetened soft drinks are harmful. – Studies contradicting or limiting the claim