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Diverging metabolic effects of 2 energy-restricted diets differing in nutrient quality: a 12-week randomized controlled trial in subjects with abdominal obesity.
Schutte, S, Esser, D, Siebelink, E, Michielsen, CJR, Daanje, M, Matualatupauw, JC, Boshuizen, HC, Mensink, M, Afman, LA
The American journal of clinical nutrition. 2022;116(1):132-150
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Energy restriction (ER) diets are considered an effective strategy for managing obesity and preventing or reducing the risk of associated comorbidities. However, there are very few previous studies comparing the quality of energy restriction diets and their effect on maximising the health benefits. Therefore, this 12-week, parallel-designed, randomised controlled trial compared the effects of a 25% high-quality ER diet with a 25% low-quality ER diet and a habitual diet on cardiometabolic risk factors of 110 participants with abdominal obesity. Both ER diets were nutritionally balanced. The high-quality ER diet had added Monounsaturated fatty acids (MUFAs), Omega-3 Polyunsaturated fatty acids (n-3 PUFAs), fibre, and plant protein and had less fructose in it. The low-quality ER diet contained Saturated fatty acids (SFAs) and monosaccharides such as fructose. At the end of the 12-week trial, participants on the 25% high-quality diet showed more promising results in weight loss, reduction in cholesterol and triglycerides, and adipose tissue gene expression of energy metabolism pathways compared to the 25% low-quality ER diet. Insulin-sensitive participants with abdominal obesity on a 25% high-quality diet lost more weight compared to the rest of the participants. Further robust studies are required to evaluate the findings due to the limitations of this study. However, healthcare professionals can use the results of this study to understand the beneficial effects of an ER diet when it is enriched with specific nutrients.
Abstract
BACKGROUND Despite the established relation between energy restriction (ER) and metabolic health, the most beneficial nutrient composition of a weight-loss diet is still a subject of debate. OBJECTIVES The aim of the study was to examine the additional effects of nutrient quality on top of ER. METHODS A parallel-designed, 12-week 25% ER dietary intervention study was conducted (clinicaltrials.gov: NCT02194504). Participants aged 40-70 years with abdominal obesity were randomized over 3 groups: a 25% ER high-nutrient-quality diet (n = 40); a 25% ER low-nutrient-quality diet (n = 40); or a habitual diet (n = 30). Both ER diets were nutritionally adequate, and the high-nutrient-quality ER diet was enriched in MUFAs, n-3 PUFAs, fiber, and plant protein and reduced in fructose. Before and after the intervention, intrahepatic lipids, body fat distribution, fasting and postprandial responses to a mixed-meal shake challenge test of cardiometabolic risk factors, lipoproteins, vascular measurements, and adipose tissue transcriptome were assessed. RESULTS The high-nutrient-quality ER diet (-8.4 ± 3.2) induced 2.1 kg more weight loss (P = 0.007) than the low-nutrient-quality ER diet (-6.3 ± 3.9), reduced fasting serum total cholesterol (P = 0.014) and plasma triglycerides (P < 0.001), promoted an antiatherogenic lipoprotein profile, and induced a more pronounced decrease in adipose tissue gene expression of energy metabolism pathways than the low-quality ER diet. Explorative analyses showed that the difference in weight loss between the two ER diets was specifically present in insulin-sensitive subjects (HOMA-IR ≤ 2.5), in whom the high-nutrient-quality diet induced 3.9 kg more weight loss than the low-nutrient-quality diet. CONCLUSIONS A high-nutrient-quality 25% ER diet is more beneficial for cardiometabolic health than a low-nutrient-quality 25% ER diet. Overweight, insulin-sensitive subjects may benefit more from a high- than a low-nutrient-quality ER diet with respect to weight loss, due to potential attenuation of glucose-induced lipid synthesis in adipose tissue.
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Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis.
Semnani-Azad, Z, Khan, TA, Blanco Mejia, S, de Souza, RJ, Leiter, LA, Kendall, CWC, Hanley, AJ, Sievenpiper, JL
JAMA network open. 2020;3(7):e209993
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Fructose is a type of sugar that has been implicated as a contributor to the development of metabolic syndrome (MetS), which is a condition where large waist circumference, high blood pressure and elevated blood lipid levels may all coexist. However, it remains unclear as to the role of fructose containing foods in the development of MetS. This systematic review and meta-analysis of 13 prospective cohort studies aimed to determine the association of several fructose containing foods and drinks with MetS. The results showed that sugary drinks containing fructose increased the risk of MetS, whereas no associations were found with mixed fruit juice, 100% fruit juice, honey, ice cream or confectionary. Interestingly fruit and yoghurt containing fructose decreased the risk of developing MetS. It was concluded that fructose containing food and drinks are not all equal in their biological effects. Sugary drinks increased the risk of developing MetS but yoghurt and fruit had a protective effect against development. Reasons for this could be due to a generally unhealthier lifestyle in those who consume sugary drinks or may be due to the increased protective effects associated with the vitamins and minerals in fruit and yoghurt. This study could be used by healthcare professionals to recommend a diet eliminating sugary drinks and containing regular fruit and yoghurt intake.
Abstract
Importance: Sugar-sweetened beverages (SSBs) are associated with increased risk of metabolic syndrome (MetS). However, the role of other important food sources of fructose-containing sugars in the development of MetS remains unclear. Objective: To examine the association of major food sources of fructose-containing sugars with incident MetS. Data Sources: MEDLINE, Embase, and Cochrane Library were searched from database inception to March 24, 2020, in addition to manual searches of reference lists from included studies using the following search terms: sugar-sweetened beverages, fruit drink, yogurt, metabolic syndrome, and prospective study. Study Selection: Inclusion criteria included prospective cohort studies of 1 year or longer that investigated the association of important food sources of fructose-containing sugars with incident MetS in participants free of MetS at the start of the study. Data Extraction and Synthesis: Study quality was assessed using the Newcastle-Ottawa Scale. Extreme quantile risk estimates for each food source with MetS incidence were pooled using a random-effects meta-analysis. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Dose-response analyses were performed using a 1-stage linear mixed-effects model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Results were reported according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Main Outcomes and Measures: Pooled risk ratio (RR) of incident MetS (pairwise and dose response). Results: Thirteen prospective cohort studies (49 591 participants [median age, 51 years; range, 6-90 years]; 14 205 with MetS) that assessed 8 fructose-containing foods and MetS were included. An adverse linear dose-response association for SSBs (RR for 355 mL/d, 1.14; 95% CI, 1.05-1.23) and an L-shaped protective dose-response association for yogurt (RR for 85 g/d, 0.66; 95% CI, 0.58-0.76) and fruit (RR for 80 g/d, 0.82; 95% CI, 0.78-0.86) was found. Fruit juices (mixed and 100%) had a U-shaped dose-response association with protection at moderate doses (mixed fruit juice: RR for 125 mL/d, 0.58; 95% CI, 0.42-0.79; 100% fruit juice: RR for 125 mL/d, 0.77; 95% CI, 0.61-0.97). Honey, ice cream, and confectionary had no association with MetS incidence. The certainty of the evidence was moderate for SSBs, yogurt, fruit, mixed fruit juice, and 100% fruit juice and very low for all other food sources. Conclusions and Relevance: The findings of this meta-analysis suggest that the adverse association of SSBs with MetS does not extend to other food sources of fructose-containing sugars, with a protective association for yogurt and fruit throughout the dose range and for 100% fruit juice and mixed fruit juices at moderate doses. Therefore, current policies and guidelines on the need to limit sources of free sugars may need to be reexamined.
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Honey does not adversely impact blood lipids of adult men and women: a randomized cross-over trial.
Al-Tamimi, AM, Petrisko, M, Hong, MY, Rezende, L, Clayton, ZS, Kern, M
Nutrition research (New York, N.Y.). 2020;74:87-95
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Restriction of sugar intake is among the most commonly advocated public health strategies, as it is believed to prevent the development of chronic diseases. Unlike sugar, honey has been shown to have various positive health benefits from increasing antioxidant status to lowering postprandial [after a meal] glycaemia and insulinaemia in healthy subjects when compared to responses of more highly refined sugar mixtures. The aim of this study was to assess responses to both short-term (1 week) and relatively long-term (1 month) ingestion of clover honey consumption versus sucrose on changes in dietary intake and serum lipid concentrations in young to middle-aged adults. This study is a crossover design randomised controlled study for which 40 participants were recruited (male [n = 21] and female [n = 19]) with an age range between 25 and 57 years. Results indicate that consumption of clover honey (1.2 g of carbohydrate per kilogram body weight) for up to 1 month produced modestly positive dietary and triglyceride effects compared to sucrose. - there were no positive lipid effects within the clover honey trial. - compared to sucrose, clover honey consumption resulted in a significantly lower intake of energy, carbohydrate, sugars and fat as well as lower triglycerides concentrations at the end of 4 weeks. Authors conclude that honey produces limited, modest health benefits relative to sucrose. Future studies are needed to investigate the possible mechanisms by which honey influences triglyceride production and/or clearance and the metabolic and hormonal regulators of food intake.
Abstract
Consumption of added sugars in the US is estimated to be approximately 1.5 times recommended levels and has been linked to increased risk for developing chronic diseases. We hypothesized that relative to sugar, honey would reduce energy intake and improve serum lipid profiles. To test this, we assessed the short-term (1-week) and relatively long-term (1-month) effects of honey versus sucrose on changes in dietary intake and serum lipid concentrations. Thirty-seven apparently healthy subjects (21 males; 16 females) aged 24-57 years (BMI = 17.6-37.2 kg/m2) completed two 4-week trials in a randomized, cross-over design separated by ≥4-week washout. During each trial, subjects consumed either clover honey or sucrose providing 1.2 g/kg/day of carbohydrate under free-living conditions with instructions to avoid changing their habitual food intake. Serum triglyceride (TG) concentrations were elevated (P < .05) after 1 week for both trials but only remained elevated (P < .05) at the 4-week time-point during sucrose consumption. The elevation after 1 week during the honey trial was concurrent with a transient increase (P < .05) in body weight. No effects on serum concentrations of insulin, total cholesterol, low density lipoprotein-cholesterol, or high density lipoprotein-cholesterol were detected for either trial. Subjects consumed significantly less energy (P < .05), carbohydrate (P < .005), sugars (P < .05), and saturated fat (P < .05) during the honey trial. These data suggest that honey may serve as a favorable substitute for sucrose with regard to reduced energy intake, carbohydrate and sugars, without negatively influencing serum lipid concentrations.
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Postexercise Glucose-Fructose Coingestion Augments Cycling Capacity During Short-Term and Overnight Recovery From Exhaustive Exercise, Compared With Isocaloric Glucose.
Gray, EA, Green, TA, Betts, JA, Gonzalez, JT
International journal of sport nutrition and exercise metabolism. 2020;30(1):54-61
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Carbohydrate is the dominant energy source during moderate-to-high-intensity exercise. During prolonged exercise, low glycogen availability is inevitable which is associated with the onset of fatigue. The aim of this study was to investigate the effect of post-exercise glucose-fructose co-ingestion versus glucose alone on subsequent cycling capacity. This study consists of two randomized, cross-over experiments. Experiment one (double-blind) employed a 4-h recovery (SHORT-EXPERIMENT), whereas, experiment two (single-blind) used a 15-h overnight recovery (OVERNIGHT-EXPERIMENT). Eight trained male cyclists participated in SHORT-EXPERIMENT whereas three female and five male trained cyclists participated in OVERNIGHT-EXPERIMENT. Results demonstrate that post-exercise glucose-fructose co-ingestion, compared to isocaloric glucose alone, augments cycling capacity following short (4-h) and overnight (15-h) recovery periods in trained cyclists. Authors conclude that endurance athletes competing in multi-stage events where recovery time is limited may benefit from consuming fructose alongside glucose in their post-exercise nutritional strategies.
Abstract
During short-term recovery, postexercise glucose-fructose coingestion can accelerate total glycogen repletion and augment recovery of running capacity. It is unknown if this advantage translates to cycling, or to a longer (e.g., overnight) recovery. Using two experiments, the present research investigated if postexercise glucose-fructose coingestion augments exercise capacity following 4-hr (short experiment; n = 8) and 15-hr (overnight experiment; n = 8) recoveries from exhaustive exercise in trained cyclists, compared with isocaloric glucose alone. In each experiment, a glycogen depleting exercise protocol was followed by a 4-hr recovery, with ingestion of 1.5 or 1.2 g·kg-1·hr-1 carbohydrate in the short experiment (double blind) and the overnight experiment (single blind), respectively. Treatments were provided in a randomized order using a crossover design. Four or fifteen hours after the glycogen depletion protocol, participants cycled to exhaustion at 70% Wmax or 65% Wmax in the short experiment and the overnight experiment, respectively. In both experiments there was no difference in substrate oxidation or blood glucose and lactate concentrations between treatments during the exercise capacity test (trial effect, p > .05). Nevertheless, cycling capacity was greater in glucose + fructose versus glucose only in the short experiment (28.0 ± 8.4 vs. 22.8 ± 7.3 min, d = 0.65, p = .039) and the overnight experiment (35.9 ± 10.7 vs. 30.6 ± 9.2 min, d = 0.53, p = .026). This is the first study to demonstrate that postexercise glucose-fructose coingestion enhances cycling capacity following short-term (4 hr) and overnight (15 hr) recovery durations. Therefore, if multistage endurance athletes are ingesting glucose for rapid postexercise recovery then fructose containing carbohydrates may be advisable.
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Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies.
Tsilas, CS, de Souza, RJ, Mejia, SB, Mirrahimi, A, Cozma, AI, Jayalath, VH, Ha, V, Tawfik, R, Di Buono, M, Jenkins, AL, et al
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2017;189(20):E711-E720
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Sugars, particularly fructose-containing sugars, have been implicated as an important driver in the rise in incidence of type 2 diabetes. The aim of this study was to determine the role of fructose-containing sugars independent of food form in the development of type 2 diabetes. This study is a systemic review and meta-analysis of prospective cohort studies. The study included 15 cohorts from 9 studies. Results indicate that intakes of total sugars and fructose were not associated with type 2 diabetes, whereas intake of sucrose was associated with an 11% decrease in type 2 diabetes. Authors conclude that in the absence of a clear signal for harm, sugars alone do not appear to explain the relation between sugar-sweetened beverages and type 2 diabetes.
Abstract
BACKGROUND Sugar-sweetened beverages are associated with type 2 diabetes. To assess whether this association holds for the fructose-containing sugars they contain, we conducted a systematic review and meta-analysis of prospective cohort studies. METHODS We searched MEDLINE, Embase, CINAHL and the Cochrane Library (through June 2016). We included prospective cohort studies that assessed the relation of fructose-containing sugars with incident type 2 diabetes. Two independent reviewers extracted relevant data and assessed risk of bias. We pooled risk ratios (RRs) using random effects meta-analyses. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Fiffeen prospective cohort studies (251 261 unique participants, 16 416 cases) met the eligibility criteria, comparing the highest intake (median 137, 35.2 and 78 g/d) with the lowest intake (median 65, 9.7 and 25.8 g/d) of total sugars, fructose and sucrose, respectively. Although there was no association of total sugars (RR 0.91, 95% confidence interval [CI] 0.76-1.09) or fructose (RR 1.04, 95% CI 0.84-1.29) with type 2 diabetes, sucrose was associated with a decreased risk of type 2 diabetes (RR 0.89, 95% CI 0.80-0.98). Our confidence in the estimates was limited by evidence of serious inconsistency between studies for total sugars and fructose, and serious imprecision in the pooled estimates for all 3 sugar categories. INTERPRETATION Current evidence does not allow us to conclude that fructose-containing sugars independent of food form are associated with increased risk of type 2 diabetes. Further research is likely to affect our estimates. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT01608620.
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Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis.
Chung, M, Ma, J, Patel, K, Berger, S, Lau, J, Lichtenstein, AH
The American journal of clinical nutrition. 2014;100(3):833-49
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There have been increasing concerns on the relationship between non-alcoholic fatty liver disease (NAFLD) and fructose or high-fructose corn syrup (HFCS). The objective of this systematic review was to assess the effect of dietary fructose in different forms on NAFLD and various biomarkers of liver health. This review included 21 published intervention studies and found a diet supplemented with fructose or glucose increases liver fat and aspartate aminotransferase (AST) concentrations when compared with a maintenance diet in healthy adults. Based on the available research, the authors point out the relationship between liver health markers and fructose, but also recognise this association may be confounded by excess energy intake. Due to the lack of robust findings, they conclude there is insufficient evidence on HFCS and NAFLD.
Abstract
BACKGROUND Concerns have been raised about the concurrent temporal trend between simple sugar intakes, especially of fructose or high-fructose corn syrup (HFCS), and rates of nonalcoholic fatty liver disease (NAFLD) in the United States. OBJECTIVE We examined the effect of different amounts and forms of dietary fructose on the incidence or prevalence of NAFLD and indexes of liver health in humans. DESIGN We conducted a systematic review of English-language, human studies of any design in children and adults with low to no alcohol intake and that reported at least one predetermined measure of liver health. The strength of the evidence was evaluated by considering risk of bias, consistency, directness, and precision. RESULTS Six observational studies and 21 intervention studies met the inclusion criteria. The overall strength of evidence for observational studies was rated insufficient because of high risk of biases and inconsistent study findings. Of 21 intervention studies, 19 studies were in adults without NAFLD (predominantly healthy, young men) and 1 study each in adults or children with NAFLD. We found a low level of evidence that a hypercaloric fructose diet (supplemented by pure fructose) increases liver fat and aspartate aminotransferase (AST) concentrations in healthy men compared with the consumption of a weight-maintenance diet. In addition, there was a low level of evidence that hypercaloric fructose and glucose diets have similar effects on liver fat and liver enzymes in healthy adults. There was insufficient evidence to draw a conclusion for effects of HFCS or sucrose on NAFLD. CONCLUSIONS On the basis of indirect comparisons across study findings, the apparent association between indexes of liver health (ie, liver fat, hepatic de novo lipogenesis, alanine aminotransferase, AST, and γ-glutamyl transpeptase) and fructose or sucrose intake appear to be confounded by excessive energy intake. Overall, the available evidence is not sufficiently robust to draw conclusions regarding effects of fructose, HFCS, or sucrose consumption on NAFLD.