Sabrina Ayoub-Charette1,2, Laura Chiavaroli1,2, Qi Liu1,2, Tauseef Ahmad Khan1,2, Andreea Zurbau1,2,3, Fei Au-Yeung1,2,3, Annette Cheung1,2, Amna Ahmed1,2, Danielle Lee1,2, Vivian L Choo1,2,4, Sonia Blanco Mejia1,2, Russell J de Souza1,2,5,6, Thomas Ms Wolever1,2,3,7,8, Lawrence A Leiter1,2,7,8,9, Cyril Wc Kendall1,2,10, David Ja Jenkins1,2,7,8,9, John L Sievenpiper1,2,7,8,9. 1. Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada. 3. INQUIS Clinical Research Ltd. (formerly Glycemic Index Laboratories, Inc.), Toronto, Ontario, Canada. 4. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 5. Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. 6. Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada. 7. Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. 8. Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 9. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 10. College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Abstract
BACKGROUND: Although fructose as a source of excess calories increases uric acid, the effect of the food matrix is unclear. OBJECTIVES: To assess the effects of fructose-containing sugars by food source at different levels of energy control on uric acid, we conducted a systematic review and meta-analysis of controlled trials. METHODS: MEDLINE, Embase, and the Cochrane Library were searched (through 11 January 2021) for trials ≥ 7 days. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars in diets); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in diets) designs. Independent reviewers (≥2) extracted data and assessed the risk of bias. Grading of Recommendations, Assessment, Development, and Evaluation was used to assess the certainty of evidence. RESULTS: We included 47 trials (85 comparisons; N = 2763) assessing 9 food sources [sugar-sweetened beverages (SSBs), sweetened dairy, fruit drinks, 100% fruit juice, fruit, dried fruit, sweets and desserts, added nutritive sweetener, and mixed sources] across 4 energy control levels in predominantly healthy, mixed-weight adults. Total fructose-containing sugars increased uric acid levels in substitution trials (mean difference, 0.16 mg/dL; 95% CI: 0.06-0.27 mg/dL; P = 0.003), with no effect across the other energy control levels. There was evidence of an interaction by food source: SSBs and sweets and desserts increased uric acid levels in the substitution design, while SSBs increased and 100% fruit juice decreased uric acid levels in addition trials. The certainty of evidence was high for the increasing effect of SSBs in substitution and addition trials and the decreasing effect of 100% fruit juice in addition trials and was moderate to very low for all other comparisons. CONCLUSIONS: Food source more than energy control appears to mediate the effects of fructose-containing sugars on uric acid. The available evidence provides reliable indications that SSBs increase and 100% fruit juice decreases uric acid levels. More high-quality trials of different food sources are needed. This trial was registered at clinicaltrials.gov as NCT02716870.
BACKGROUND: Although fructose as a source of excess calories increases uric acid, the effect of the food matrix is unclear. OBJECTIVES: To assess the effects of fructose-containing sugars by food source at different levels of energy control on uric acid, we conducted a systematic review and meta-analysis of controlled trials. METHODS: MEDLINE, Embase, and the Cochrane Library were searched (through 11 January 2021) for trials ≥ 7 days. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars in diets); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in diets) designs. Independent reviewers (≥2) extracted data and assessed the risk of bias. Grading of Recommendations, Assessment, Development, and Evaluation was used to assess the certainty of evidence. RESULTS: We included 47 trials (85 comparisons; N = 2763) assessing 9 food sources [sugar-sweetened beverages (SSBs), sweetened dairy, fruit drinks, 100% fruit juice, fruit, dried fruit, sweets and desserts, added nutritive sweetener, and mixed sources] across 4 energy control levels in predominantly healthy, mixed-weight adults. Total fructose-containing sugars increased uric acid levels in substitution trials (mean difference, 0.16 mg/dL; 95% CI: 0.06-0.27 mg/dL; P = 0.003), with no effect across the other energy control levels. There was evidence of an interaction by food source: SSBs and sweets and desserts increased uric acid levels in the substitution design, while SSBs increased and 100% fruit juice decreased uric acid levels in addition trials. The certainty of evidence was high for the increasing effect of SSBs in substitution and addition trials and the decreasing effect of 100% fruit juice in addition trials and was moderate to very low for all other comparisons. CONCLUSIONS: Food source more than energy control appears to mediate the effects of fructose-containing sugars on uric acid. The available evidence provides reliable indications that SSBs increase and 100% fruit juice decreases uric acid levels. More high-quality trials of different food sources are needed. This trial was registered at clinicaltrials.gov as NCT02716870.
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Authors: Danielle Lee; Laura Chiavaroli; Sabrina Ayoub-Charette; Tauseef A Khan; Andreea Zurbau; Fei Au-Yeung; Annette Cheung; Qi Liu; Xinye Qi; Amna Ahmed; Vivian L Choo; Sonia Blanco Mejia; Vasanti S Malik; Ahmed El-Sohemy; Russell J de Souza; Thomas M S Wolever; Lawrence A Leiter; Cyril W C Kendall; David J A Jenkins; John L Sievenpiper Journal: Nutrients Date: 2022-07-12 Impact factor: 6.706
Authors: XinYe Qi; Laura Chiavaroli; Danielle Lee; Sabrina Ayoub-Charette; Tauseef A Khan; Fei Au-Yeung; Amna Ahmed; Annette Cheung; Qi Liu; Sonia Blanco Mejia; Vivian L Choo; Russell J de Souza; Thomas M S Wolever; Lawrence A Leiter; Cyril W C Kendall; David J A Jenkins; John L Sievenpiper Journal: Nutrients Date: 2022-09-26 Impact factor: 6.706