Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
J Nutr. 2021 Aug 7;151(8):2409-2421. doi: 10.1093/jn/nxab144.
Although fructose as a source of excess calories increases uric acid, the effect of the food matrix is unclear.
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.
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.
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.
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.
尽管果糖作为过量卡路里的来源会增加尿酸，但食物基质的影响尚不清楚。
通过不同能量控制水平下的食物来源评估含果糖的糖对尿酸的影响，我们对对照试验进行了系统评价和荟萃分析。
通过 11 月 11 日对 MEDLINE、Embase 和 Cochrane 图书馆进行检索，对持续时间≥7 天的试验进行检索。我们根据能量控制预先设定了 4 种试验设计：替代（饮食中糖的能量匹配替代）；添加（饮食中添加糖的多余能量）；减去（饮食中减去糖的能量）；和随意（饮食中糖的能量自由替代）设计。独立审查员（≥2 名）提取数据并评估偏倚风险。使用推荐评估、制定与评估分级系统（Grading of Recommendations, Assessment, Development, and Evaluation）评估证据的确定性。
我们纳入了 47 项试验（85 项比较；N=2763），评估了 9 种食物来源[含糖饮料（SSB）、加糖乳制品、果汁饮料、100%纯果汁、水果、果脯、甜食和甜点、添加营养甜味剂和混合来源]，涵盖了在健康、混合体重成年人中 4 种不同的能量控制水平。在替代试验中，总含果糖的糖增加了尿酸水平（平均差异为 0.16 mg/dL；95%置信区间：0.06-0.27 mg/dL；P=0.003），而在其他能量控制水平上则没有影响。证据表明食物来源有交互作用：SSB 和甜食和甜点在替代设计中增加了尿酸水平，而 SSB 在添加试验中增加，100%纯果汁则降低了尿酸水平。SSB 在替代和添加试验中增加尿酸水平以及 100%纯果汁在添加试验中降低尿酸水平的证据确定性较高，而所有其他比较的证据确定性为中至高。
食物来源似乎比能量控制更能调节含果糖的糖对尿酸的影响。现有证据提供了可靠的证据，表明 SSB 增加，100%纯果汁降低尿酸水平。需要更多不同食物来源的高质量试验。该试验在 clinicaltrials.gov 上注册为 NCT02716870。
