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Juraschek SP, Gaziano JM, Glynn RJ, Gomelskaya N, Bubes VY, Buring JE, Shmerling RH, Sesso HD. Effects of vitamin C supplementation on gout risk: results from the Physicians' Health Study II trial. Am J Clin Nutr 2022; 116:812-819. [PMID: 35575611 PMCID: PMC9437983 DOI: 10.1093/ajcn/nqac140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Short-term randomized trials suggest that a 500 mg/d vitamin C supplement reduces serum urate, whereas observational studies show vitamin E is inversely associated with gout risk. OBJECTIVES We evaluated the effect of supplemental vitamin C (prespecified primary exposure) and vitamin E (prespecified secondary exposure) on new diagnoses of gout. METHODS We performed a post hoc analysis of data from the Physicians' Health Study II, a randomized, double-blind, placebo-controlled factorial trial of randomized vitamin C (500 mg/d) and vitamin E (400 IU every other day). The primary outcome was new gout diagnoses, self-reported at baseline and throughout the follow-up period of ≤10 y. RESULTS Of 14,641 randomly assigned male physicians in our analysis, the mean age was 64 ± 9 y; 1% were Black, and 6.5% had gout prior to randomization. The incidence rate of new gout diagnoses during follow-up was 8.0 per 1000 person-years among those assigned vitamin C compared with 9.1 per 1000 person-years among those assigned placebo. The vitamin C assignment reduced new gout diagnoses by 12% (HR: 0.88; 95% CI: 0.77, 0.99; P = 0.04). These effects were greatest among those with a BMI <25 kg/m 2 (P-interaction = 0.01). Vitamin E was not associated with new gout diagnoses (HR: 1.05; 95% CI: 0.92, 1.19; P = 0.48). CONCLUSIONS Vitamin C modestly reduced the risk of new gout diagnoses in middle-aged male physicians. Additional research is needed to determine the effects of higher doses of vitamin C supplementation on serum urate and gout flares in adults with established gout.The Physicians' Health Study II is registered at clinicaltrials.gov (identifier: NCT00270647).
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Affiliation(s)
- Stephen P Juraschek
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J Michael Gaziano
- Division of Aging, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Robert J Glynn
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Natalya Gomelskaya
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Vadim Y Bubes
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert H Shmerling
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Howard D Sesso
- Division of Aging, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Price CA, Medici V, Nunez MV, Lee V, Sigala DM, Benyam Y, Keim NL, Mason AE, Chen SY, Parenti M, Slupsky C, Epel ES, Havel PJ, Stanhope KL. A Pilot Study Comparing the Effects of Consuming 100% Orange Juice or Sucrose-Sweetened Beverage on Risk Factors for Cardiometabolic Disease in Women. Nutrients 2021; 13:760. [PMID: 33652807 PMCID: PMC7996959 DOI: 10.3390/nu13030760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
Overconsumption of sugar-sweetened beverages increases risk factors associated with cardiometabolic disease, in part due to hepatic fructose overload. However, it is not clear whether consumption of beverages containing fructose as naturally occurring sugar produces equivalent metabolic dysregulation as beverages containing added sugars. We compared the effects of consuming naturally-sweetened orange juice (OJ) or sucrose-sweetened beverages (sucrose-SB) for two weeks on risk factors for cardiometabolic disease. Healthy, overweight women (n = 20) were assigned to consume either 3 servings of 100% orange juice or sucrose-SB/day. We conducted 16-hour serial blood collections and 3-h oral glucose tolerance tests during a 30-h inpatient visit at baseline and after the 2-week diet intervention. The 16-h area under the curve (AUC) for uric acid increased in subjects consuming sucrose-SB compared with subjects consuming OJ. Unlike sucrose-SB, OJ did not significantly increase fasting or postprandial lipoproteins. Consumption of both beverages resulted in reductions in the Matsuda insulin sensitivity index (OJ: -0.40 ± 0.18, p = 0.04 within group; sucrose-SB: -1.0 ± 0.38, p = 0.006 within group; p = 0.53 between groups). Findings from this pilot study suggest that consumption of OJ at levels above the current dietary guidelines for sugar intake does not increase plasma uric acid concentrations compared with sucrose-SB, but appears to lead to comparable decreases of insulin sensitivity.
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Affiliation(s)
- Candice Allister Price
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA; (V.L.); (D.M.S.); (Y.B.); (P.J.H.); (K.L.S.)
| | - Valentina Medici
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine (V.M.), University of California Davis, Sacramento, CA 95817, USA;
| | - Marinelle V. Nunez
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA; (M.V.N.); (N.L.K.); (S.-Y.C.); (M.P.); (C.S.)
| | - Vivien Lee
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA; (V.L.); (D.M.S.); (Y.B.); (P.J.H.); (K.L.S.)
| | - Desiree M. Sigala
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA; (V.L.); (D.M.S.); (Y.B.); (P.J.H.); (K.L.S.)
| | - Yanet Benyam
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA; (V.L.); (D.M.S.); (Y.B.); (P.J.H.); (K.L.S.)
| | - Nancy L. Keim
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA; (M.V.N.); (N.L.K.); (S.-Y.C.); (M.P.); (C.S.)
- Western Human Nutrition Research Center, Agricultural Research Service, USDA, Davis, CA 95616, USA
| | - Ashley E. Mason
- Osher Center for Integrative Medicine, School of Medicine, University of California San Francisco, San Francisco, CA 94155, USA;
| | - Shin-Yu Chen
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA; (M.V.N.); (N.L.K.); (S.-Y.C.); (M.P.); (C.S.)
| | - Mariana Parenti
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA; (M.V.N.); (N.L.K.); (S.-Y.C.); (M.P.); (C.S.)
| | - Carolyn Slupsky
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA; (M.V.N.); (N.L.K.); (S.-Y.C.); (M.P.); (C.S.)
| | - Elissa S. Epel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Peter J. Havel
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA; (V.L.); (D.M.S.); (Y.B.); (P.J.H.); (K.L.S.)
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA; (M.V.N.); (N.L.K.); (S.-Y.C.); (M.P.); (C.S.)
| | - Kimber L. Stanhope
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA; (V.L.); (D.M.S.); (Y.B.); (P.J.H.); (K.L.S.)
- Basic Sciences, Touro University of California, Vallejo, CA 94592, USA
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Role of Vitamin C in Prophylaxis and Treatment of Gout-A Literature Review. Nutrients 2021; 13:nu13020701. [PMID: 33671646 PMCID: PMC7926958 DOI: 10.3390/nu13020701] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022] Open
Abstract
Gout, known as “the disease of the kings”, is the most frequent type of arthritis. It results from sustained hyperuricemia that leads to monosodium urate crystal deposition in joint structures and soft tissue. Environmental factors such as diet affect the incidence of gout; there is a known relationship between the occurrence of an acute attack of gout and the consumption of alcohol and meat; and a low purine diet is a widely recognized nonpharmacological method of supplementing the treatment and preventing recurrence of arthritis. This review aims to summarize the current knowledge about the role of vitamin C in prevention and treatment of gout. A PubMed/Medline database search on the role of vitamin C in purine metabolism was done. Reports from in vitro and animal studies seem to be promising and to allow explanation of the physiological relationship between vitamin C and uric acid. Most epidemiological studies indicate a significant correlation between high vitamin C intake and lower serum uric acid levels. Despite promising observations, there are few observational and interventional studies, and their results do not clearly define the benefits of a high daily intake of vitamin C in preventing the development and recurrence of gout.
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