Fructose malabsorption in people with and without gout: A case–control study

• Published in: Seminars in arthritis and rheumatism Vol. 47; no. 2; pp. 257 - 263
• Main Authors: Batt, Caitlin, MBChB, Fanning, Niamh, PhD, Drake, Jill, BN, Frampton, Christopher, PhD, Gearry, Richard B., MBChB, FRACP, PhD, Stamp, Lisa K., MBChB, FRACP, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2017
• Subjects: Aged; Body Mass Index; Breath Tests; Case-Control Studies; Comorbidity; Female; Fructose; Fructose - metabolism; Gout; Gout - epidemiology; Gout - metabolism; Humans; Malabsorption Syndromes - epidemiology; Malabsorption Syndromes - metabolism; Male; Middle Aged; Prevalence; Rheumatology; Serum urate; SU; SSB; irritable bowel syndrome; Gout; area under the curve; American Rheumatism Association; serum urate; Fructose; AUC; ARA; adenosine triphosphate; sugar-sweetened beverage; SEM; IBS; standard error of the mean; ATP; Serum urate
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/j.semarthrit.2017.03.018

Abstract Background Higher fructose intake has been associated with hyperuricaemia and gout. Some individuals malabsorb fructose in the small intestine. The aims of this study were to determine the rate of fructose malabsorption and the effects of gout and fructose malabsorption on serum urate in people with and without gout. Methods A total of 100 people with gout (cases) were age and gender matched with one control without gout. After a low fructose diet, fructose malabsorption was measured using a hydrogen and methane breath test with a 35 g fructose load. In a subgroup of 35 cases and 35 controls, serum urate response to the fructose load over 240 minutes was measured. Results There was no significant difference in the rate of fructose malabsorption between cases and controls (48% vs. 52%; p = 0.67). Cases had a significantly lower mean (SEM) serum urate cumulative incremental concentration from baseline-240 minutes (iAUC0-240 ) compared to controls 0.97 (0.56) vs. 4.78 (0.55); p < 0.001. Cmax was significantly lower in cases compared to controls [0.38 (0.003) vs. 0.40 (0.003); p < 0.001]. 95% of cases were receiving allopurinol. There was no significant difference between iAUC0-240 or Cmax for malabsorbers compared to normal absorbers irrespective of case–control status. The mean (SEM) increase in serum urate between baseline and 30 minutes was 0.04 (0.004) mmol/l in the controls compared to 0.009 (0.002) in the cases ( p < 0.001). Conclusion The rates of fructose malabsorption are similar in people with and without gout. Allopurinol inhibits the increase in serum urate induced by a fructose load suggesting that people with gout receiving allopurinol may not need to restrict dietary intake of fructose.