The prevalence of gout rises with advancing age. Among men and women older than 80 years of age, the prevalence of the disorder is 9% and 6%, respectively. Gout is more common among individuals with lower family income levels. This is probably attributable to a disproportionate occurrence within those income strata of other risk factors for gout, including hypertension, obesity, and dietary patterns. Ethanol or fructose consumption increases uric acid production by net adenosine triphosphate (ATP) degradation to adenosine monophosphate (AMP). AMP is degraded rapidly to uric acid. Two major genetic mutations lead to gout, urolithiasis, and related problems: Mutations in the gene that encodes hypoxanthine-guanine phosphoribosyl transferase are associated with a spectrum of diseases in children, which ranges from the Lesch—Nyhan syndrome at the severe end of the spectrum to simple hyperuricemia at the mild end. Mutations in the 5'-phosphoribosyl-1-pyrophosphate (PRPP) synthetase genes can result in overactivity of the pathway, leading ultimately to increased urate production.


Uric Acid Serum Uric Acid Serum Uric Acid Level Dairy Consumption Serum Uric Acid Concentration 
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  1. Anderson JW, Story LJ, Zettwoch NC, Gustafson NJ, Jefferson BS. Metabolic effects of fructose supplementation in diabetic individuals. Diabetes Care. 1989;12:337–44PubMedCrossRefGoogle Scholar
  2. Arnlov J, Vessby B, Riserus U. Coffee consumption and insulin sensitivity. JAMA 2004;291:1199–201PubMedCrossRefGoogle Scholar
  3. Arromdee E, Michet CJ, Crowson CS, O'Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol. 2002;29:2403–6PubMedGoogle Scholar
  4. Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr. 2004;79:537–43PubMedGoogle Scholar
  5. Choi HK, Atkinson K, Karlson EW, Willett WC, Curhan G. Alcohol intake and risk of incident gout in men — a prospective study. Lancet 2004a;363:1277–81CrossRefGoogle Scholar
  6. Choi HK, Atkinson K, Karlson EW, Willett WC, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004b;350:1093–103CrossRefGoogle Scholar
  7. Choi HK, Curhan G. Beer, liquor, wine, and serum uric acid level — the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2004;1023–9Google Scholar
  8. Choi HK, Curhan G. Coffee, tea, and caffeine consumption and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2007a;57:816–21CrossRefGoogle Scholar
  9. Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation 2007b;116:894–900CrossRefGoogle Scholar
  10. Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ 2008;336:309–12PubMedCrossRefGoogle Scholar
  11. Choi HK, Ford ES. Haemoglobin A1c, fasting glucose, serum C-peptide and insulin resistance in relation to serum uric acid levels — the Third National Health and Nutrition Examination Survey. Rheumatology (Oxford) 2008;47:713–7CrossRefGoogle Scholar
  12. Choi HK, Ford ES, Li C, Curhan G. Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2007a;57:109–15CrossRefGoogle Scholar
  13. Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, dairy products, and serum uric acid level – the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005a;52:283–9CrossRefGoogle Scholar
  14. Choi HK, Mount DB, Reginato AM. Pathogenesis of gout. Ann Intern Med. 2005b;143:499–516CrossRefGoogle Scholar
  15. Choi HK, Willett W, Curhan G. Coffee consumption and risk of incident gout in men: a prospective study. Arthritis Rheum. 2007b;56: 2049–55CrossRefGoogle Scholar
  16. Choi HK Gao X, Curhan G. Vitamin C intake and the risk of gout in men: a prospective study. Arch Intern Med 2009;169:502–7PubMedCrossRefGoogle Scholar
  17. Choi JW, Ford ES, Gao X, Choi HK. Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2008;59:109–16PubMedCrossRefGoogle Scholar
  18. Cohen SD, Kimmel PL, Neff R, Agodoa L, Abbott KC. Association of incident gout and mortality in dialysis patients. J Am Soc Nephrol. 2008;19:2204–10PubMedCrossRefGoogle Scholar
  19. Cook DG, Shaper AG, Thelle DS, Whitehead TP. Serum uric acid, serum glucose and diabetes: relationships in a population study. Postgrad Med J. 1986;62:1001–6PubMedCrossRefGoogle Scholar
  20. Dessein PH, Shipton EA, Stanwix AE, Joffe BI, Ramokgadi J. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis. 2000;59:539–43PubMedCrossRefGoogle Scholar
  21. Emmerson B. Hyperlipidaemia in hyperuricaemia and gout. Ann Rheum Dis. 1998;57:509–10PubMedCrossRefGoogle Scholar
  22. Enomoto A, Kimura H, Chairoungdua A, et al Molecular identification of a renal urate anion exchanger that regulates blood urate levels. Nature 2002; 417:447–52PubMedGoogle Scholar
  23. Eriksson KF, Lindgarde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study. Diabetologia 1991;34:891–8Google Scholar
  24. Facchini F, Chen YD, Hollenbeck CB, Reaven GM. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA 1991;266:3008–11PubMedCrossRefGoogle Scholar
  25. Faller J, Fox IH. Ethanol-induced hyperuricemia: evidence for increased urate production by activation of adenine nucleotide turnover. N Engl J Med. 1982;307:1598–602PubMedCrossRefGoogle Scholar
  26. Fam AG. Gout, diet, and the insulin resistance syndrome. J Rheumatol. 2002;29:1350–5PubMedGoogle Scholar
  27. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care 2005;28:1769–78PubMedCrossRefGoogle Scholar
  28. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356–9PubMedCrossRefGoogle Scholar
  29. Fox IH, Kelley WN. Studies on the mechanism of fructose-induced hyperuricemia in man. Metabolism 1972;21:713–21PubMedCrossRefGoogle Scholar
  30. Fox IH, Palella TD, Kelley WN. Hyperuricemia: a marker for cell energy crisis. N Engl J Med. 1987;317:111–2PubMedCrossRefGoogle Scholar
  31. Gao X, Qi L, Qiao N, et al Intake of added sugar and sugar-sweetened drink and serum uric acid concentration in US men and women. Hypertension 2007; 50:306–12PubMedCrossRefGoogle Scholar
  32. Garrel DR, Verdy M, PetitClerc C, Martin C, Brule D, Hamet P. Milk-and soy-protein ingestion: acute effect on serum uric acid concentration. Am J Clin Nutr. 1991;53:665–9PubMedGoogle Scholar
  33. Ghadirian P, Shatenstein B, Verdy M, Hamet P. The influence of dairy products on plasma uric acid in women. Eur J Epidemiol. 1995; 11:275–81CrossRefGoogle Scholar
  34. Gibson T, Rodgers AV, Simmonds HA, Court-Brown F, Todd E, Meilton V. A controlled study of diet in patients with gout. Ann Rheum Dis. 1983;42:123–7PubMedCrossRefGoogle Scholar
  35. Gross LS, Li L, Ford ES, Liu S. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr. 2004;79:774–9PubMedGoogle Scholar
  36. Grundy SM, Cleeman JI, Daniels SR, et al Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–52PubMedCrossRefGoogle Scholar
  37. Herman JB, Goldbourt U. Uric acid and diabetes: observations in a population study. Lancet 1982;2:240–3PubMedCrossRefGoogle Scholar
  38. Hochberg MC, Thomas J, Thomas DJ, Mead L, Levine DM, Klag MJ. Racial differences in the incidence of gout. The role of hypertension. Arthritis Rheum. 1995;38:628–32CrossRefGoogle Scholar
  39. Huang HY, Appel LJ, Choi MJ, et al The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum. 2005;52:1843–7PubMedCrossRefGoogle Scholar
  40. Kiyohara C, Kono S, Honjo S, et al Inverse association between coffee drinking and serum uric acid concentrations in middle-aged Japanese males. Br J Nutr. 1999;82:125–30PubMedGoogle Scholar
  41. Kramer HM, Curhan G. The association between gout and nephrolithia-sis: the National Health and Nutrition Examination Survey III, 1988–1994. Am J Kidney Dis. 2002;40:37–42PubMedCrossRefGoogle Scholar
  42. Krishnan E, Svendsen K, Neaton JD, Grandits G, Kuller LH. Long-term cardiovascular mortality among middle-aged men with gout. Arch Intern Med. 2008;168:1104–10PubMedCrossRefGoogle Scholar
  43. Lee J, Sparrow D, Vokonas PS, Landsberg L, Weiss ST. Uric acid and coronary heart disease risk: evidence for a role of uric acid in the obesity–insulin resistance syndrome. The Normative Aging Study. Am J Epidemiol. 1995;142:288–94Google Scholar
  44. Lee WY, Park JS, Noh SY, Rhee EJ, Kim SW, Zimmet PZ. Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract. 2004;65:143–9PubMedCrossRefGoogle Scholar
  45. Loenen HM, Eshuis H, Lowik MR, et al Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch Nutrition Surveillance System). J Clin Epidemiol. 1990;43:1297–303PubMedCrossRefGoogle Scholar
  46. Lyu LC, Hsu CY, Yeh CY, Lee MS, Huang SH, Chen CL. A case– control study of the association of diet and obesity with gout in Taiwan. Am J Clin Nutr. 2003;78:690–701PubMedGoogle Scholar
  47. Muscelli E, Natali A, Bianchi S, et al Effect of insulin on renal sodium and uric acid handling in essential hypertension. Am J Hypertens. 1996;9:746–52PubMedCrossRefGoogle Scholar
  48. Nakagawa T, Tuttle KR, Short RA, Johnson RJ. Hypothesis: fructose-induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome. Nat Clin Pract Nephrol. 2005; 1: 80–6PubMedCrossRefGoogle Scholar
  49. Osler W, Gout. The principles and practice of medicine. New York: Appleton; 1893. p. 287–95Google Scholar
  50. Pan XR, Li GW, Hu YH, et al Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20:537–44PubMedCrossRefGoogle Scholar
  51. Puig JG, Fox IH. Ethanol-induced activation of adenine nucleotide turnover. Evidence for a role of acetate. J Clin Invest. 1984;74: 936–41PubMedCrossRefGoogle Scholar
  52. Raivio KO, Becker A, Meyer LJ, Greene ML, Nuki G, Seegmiller JE. Stimulation of human purine synthesis de novo by fructose infusion. Metabolism 1975;24:861–9PubMedCrossRefGoogle Scholar
  53. Rasch EK, Hirsch R, Paulose-Ram R, Hochberg MC. Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States: effect of different methods of case classification. Arthritis Rheum. 2003;48:917–26PubMedCrossRefGoogle Scholar
  54. Rathmann W, Funkhouser E, Dyer AR, Roseman JM. Relations of hyperuricemia with the various components of the insulin resistance syndrome in young black and white adults: the CARDIA study. Coronary Artery Risk Development in Young Adults. Ann Epidemiol. 1998;8:250–61Google Scholar
  55. Rho YH, Choi SJ, Lee YH, et al The prevalence of metabolic syndrome in patients with gout: a multicenter study. J Korean Med Sci. 2005; 20:1029–33PubMedCrossRefGoogle Scholar
  56. Stein HB, Hasan A, Fox IH. Ascorbic acid-induced uricosuria. A consequence of megavitamin therapy. Ann Intern Med. 1976;84:385–8PubMedCrossRefGoogle Scholar
  57. Ter Maaten JC, Voorburg A, Heine RJ, Ter Wee PM, Donker AJ, Gans RO. Renal handling of urate and sodium during acute physiological hyperinsulinaemia in healthy subjects. Clin Sci (Lond). 1997;92: 51–8Google Scholar
  58. Thorburn AW, Storlien LH, Jenkins AB, Khouri S, Kraegen EW. Fructose-induced in vivo insulin resistance and elevated plasma triglyceride levels in rats. Am J Clin Nutr. 1989;49:1155–63PubMedGoogle Scholar
  59. Tordoff MG, Alleva AM. Effect of drinking soda sweetened with aspar-tame or high-fructose corn syrup on food intake and body weight. Am J Clin Nutr. 1990;51:963–9PubMedGoogle Scholar
  60. Tuomilehto J, Lindstrom J, Eriksson JG, et al Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50PubMedCrossRefGoogle Scholar
  61. Tuomilehto J, Zimmet P, Wolf E, Taylor R, Ram P, King H. Plasma uric acid level and its association with diabetes mellitus and some biologic parameters in a biracial population of Fiji. Am J Epidemiol. 1988;127:321–36PubMedGoogle Scholar
  62. Vazquez-Mellado J, Conrado GG, Vazquez SG, et al Metabolic syndrome and ischemic heart disease in gout. J Clin Rheumatol. 2004; 10:105–9PubMedCrossRefGoogle Scholar
  63. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20:895–900PubMedCrossRefGoogle Scholar
  64. Whitehead TP, Jungner I, Robinson D, Kolar W, Pearl A, Hale A. Serum urate, serum glucose and diabetes. Ann Clin Biochem. 1992;29 (Pt 2):159–61PubMedGoogle Scholar
  65. Willett WC, Stampfer MJ. Rebuilding the food pyramid. Sci Am. 2003;288:64–71PubMedCrossRefGoogle Scholar
  66. Wu T, Giovannucci E, Pischon T, et al Fructose, glycemic load, and quantity and quality of carbohydrate in relation to plasma C-peptide concentrations in US women. Am J Clin Nutr. 2004;80:1043–9PubMedGoogle Scholar
  67. Wu T, Willett WC, Hankinson SE, Giovannucci E. Caffeinated coffee, decaffeinated coffee, and caffeine in relation to plasma C-peptide levels, a marker of insulin secretion, in U.S. women. Diabetes Care. 2005;28:1390–6CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Hyon K. Choi
    • 1
  1. 1.Department of MedicineBoston University School of MedicineBostonUSA

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