-
1.
Effect of fructose instead of glucose or sucrose on cardiometabolic markers: a systematic review and meta-analysis of isoenergetic intervention trials.
Fattore, E, Botta, F, Bosetti, C
Nutrition reviews. 2021;(2):209-226
Abstract
CONTEXT Free, or added, sugars are considered important determinants in the pandemics of obesity and associated chronic diseases, and fructose has emerged as the sugar of main concern. OBJECTIVE The aim of this review was to assess the evidence of the effects of isoenergetic replacement of fructose or high-fructose corn syrup (HFCS) for glucose or sucrose on cardiometabolic markers in controlled dietary intervention trials. DATA SOURCES The electronic databases PubMed/MEDLINE, the Cochrane Library, and Embase were searched from 1980 to May 5, 2020. STUDY SELECTION Studies were eligible if they measured at least one of the following outcomes: total cholesterol, low- and high-density lipoprotein cholesterol, triacylglycerols, apolipoprotein A1, apolipoprotein B, systolic blood pressure, diastolic blood pressure, fasting glucose, and body weight. DATA EXTRACTION For each outcome, the mean values and the corresponding measure of dispersion were extracted after the intervention or control diet. DATA ANALYSIS Fixed-effects and random-effects models were used to pool study-specific estimates. Between-study heterogeneity was assessed by the χ2 test and the I2 statistic and publication bias by the Egger test and funnel plots. RESULTS Twenty-five studies involving 1744 volunteers were identified. No significant effects were found when fructose or HFCS was substituted for glucose, except for a slight decrease in diastolic blood pressure when fructose was substituted for glucose. Similarly, no effects were found when fructose or HFCS was substituted for sucrose, except for a small increase, of uncertain clinical significance, of apolipoprotein B when HFCS was substituted for sucrose. CONCLUSIONS Isoenergetic substitution of fructose or HFCS for glucose or sucrose has no significant effect on most of the cardiometabolic markers investigated; however, some results were affected by residual between-study heterogeneity and studies with high or unclear risk of bias. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42016042930.
-
2.
Effect of fructose and its epimers on postprandial carbohydrate metabolism: A systematic review and meta-analysis.
Braunstein, CR, Noronha, JC, Khan, TA, Mejia, SB, Wolever, TM, Josse, RG, Kendall, CW, Sievenpiper, JL
Clinical nutrition (Edinburgh, Scotland). 2020;(11):3308-3318
Abstract
AIMS: To synthesize the evidence of the effect of small doses (≤30-g/meal) of fructose and its epimers (allulose, tagatose, and sorbose) on the postprandial glucose and insulin response to carbohydrate-containing meals. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through to April 9, 2019. We included randomized (RCTs) and non-randomized acute, single-meal, controlled feeding trials that added ≤30-g of fructose or its epimers either prior to or with a carbohydrate-containing meal compared with the same meal alone. Outcomes included the incremental area under the curve (iAUC) for glucose and insulin, the Matsuda Insulin Sensitivity Index, and the Early Insulin Secretion Index. Data were expressed as ratio of means (RoM) with 95% CIs and pooled using the inverse variance method. The overall certainty of the evidence was evaluated using GRADE. RESULTS Forty trial comparisons (n = 400) were included (none for sorbose). Allulose significantly reduced the postprandial iAUC glucose response by 10% (0.90 [0.84 to 0.96], P < 0.01). Tagatose significantly reduced the postprandial iAUC insulin response by 25% (0.75 [0.62 to 0.91], P < 0.01) and showed a non-significant 3% reduction in the postprandial iAUC glucose response (0.97 [0.94 to 1.00], P = 0.07). There was no effect of fructose on any outcome. The certainty of the evidence was graded as low to moderate for fructose, moderate for allulose, and low for tagatose. CONCLUSIONS Small doses of allulose and tagatose, but not fructose, lead to modest improvements on postprandial glucose and insulin regulation. There is a need for long-term RCTs to confirm the sustainability of these improvements.
-
3.
Consumption of sugar sweetened beverages and dietary fructose in relation to risk of gout and hyperuricemia: a systematic review and meta-analysis.
Ebrahimpour-Koujan, S, Saneei, P, Larijani, B, Esmaillzadeh, A
Critical reviews in food science and nutrition. 2020;(1):1-10
Abstract
Background: Findings on the association of sugar sweetened beverages (SSB) and fructose intakes with gout and hyperuricemia have been conflicting.Objective: We aimed to perform a systematic review and meta-analysis on studies that examined the association of SSB and fructose consumption with gout and hyperuricemia in adults.Methods: We searched PubMed, Scopus and Google Scholar up to Aug 2017 for all relevant published papers assessing SSB and fructose intakes and risk of gout and hyperuricemia. After excluding non-relevant papers, 10 studies remained in our systematic. Meta-analysis on SSB consumption and risk of gout was done on three effect sizes from cohort studies and five effect sizes from case-control studies. For risk of hyperuricemia, the meta-analysis was done on six effect sizes from cross-sectional studies. All analyses were performed on ORs or RRs.Results: We found an overall significant positive association between SSB consumption and risk of gout in both cohort (summary effect size: 1.35; 95% CI: 1.18-1.55) and case-control studies (summary effect size: 1.33; 95% CI: 1.06-1.66). Meta-analysis on cross-sectional studies revealed that SSB consumption was associated with 35% greater odds of hyperuricemia (summary effect size: 1.35; 95% CI: 1.19-1.52). No evidence of between-study heterogeneity as well as publication bias was found. Although the studies on fructose intake and risk of gout and hyperuricemia were included in our systematic review, we did not perform met-analysis on these studies due to insufficient number of publications.Conclusion: We found that SSB consumption was significantly associated with increased risk of gout and hyperuricemia in adult population. Further studies are needed to examine the association between dietary fructose intake and risk of gout and hyepruricemia.
-
4.
Effects of fructose consumption on postprandial TAG: an update on systematic reviews with meta-analysis.
Macedo, RCO, Vieira, AF, Moritz, CEJ, Reischak-Oliveira, A
The British journal of nutrition. 2018;(4):364-372
Abstract
The aim of this study was to re-examine the chronic effect (>7 d) of fructose consumption on postprandial TAG, in adolescents and adults. The research was carried out in March 2017 and used different electronic databases, such as Medline ® (Pubmed®), Embase® and Cochrane. The review considered clinical trials (parallel or crossed) that evaluated the effect of fructose consumption for a period longer than 7 d, in humans. Two investigators independently performed data extraction. The outcome was the absolute delta of TAG concentration in a 4-h postprandial period. The results were presented with delta mean difference between treatments with 95 % CI. The calculations were made based on random-effect models. Statistical heterogeneity of treatment effects between studies was assessed by Cochrane's 'Q Test' and 'I 2' inconsistency test. The meta-analysis of the twelve selected interventions (n 318) showed that fructose generated larger variation (δ) of TAG concentrations during the postprandial period, compared with other carbohydrates (mean difference: 8·02 (95 % CI 0·46, 15·58) mg/dl (0·09 (95 % CI 0·01, 0·18) mmol/l); I 2: 74 %). High heterogeneity was generated almost exclusively by one study, and its withdrawal did not alter the result. We concluded that chronic consumption of fructose (>7 d) has a negative role on postprandial TAG in healthy adolescents and adults, as well as in overweight/obese individuals, but not in diabetics.
-
5.
Chronic fructose substitution for glucose or sucrose in food or beverages has little effect on fasting blood glucose, insulin, or triglycerides: a systematic review and meta-analysis.
Evans, RA, Frese, M, Romero, J, Cunningham, JH, Mills, KE
The American journal of clinical nutrition. 2017;(2):519-529
-
-
Free full text
-
Abstract
Background: Conflicting evidence exists on the role of long-term fructose consumption on health. No systematic review has addressed the effect of isoenergetic fructose replacement of other sugars and its effect on glycated hemoglobin (HbA1c), fasting blood glucose, insulin, and triglycerides.Objective: The objective of this study was to review the evidence for a reduction in fasting glycemic and insulinemic markers after chronic, isoenergetic replacement of glucose or sucrose in foods or beverages by fructose. The target populations were persons without diabetes, those with impaired glucose tolerance, and those with type 2 diabetes.Design: We searched the Cochrane Library, MEDLINE, EMBASE, the WHO International Clinical Trials Registry Platform Search Portal, and clinicaltrials.gov The date of the last search was 26 April 2016. We included randomized controlled trials of isoenergetic replacement of glucose, sucrose, or both by fructose in adults or children with or without diabetes of ≥2 wk duration that measured fasting blood glucose. The main outcomes analyzed were fasting blood glucose and insulin as well as fasting triglycerides, blood lipoproteins, HbA1c, and body weight.Results: We included 14 comparison arms from 11 trials, including 277 patients. The studies varied in length from 2 to 10 wk (mean: 28 d) and included doses of fructose between 40 and 150 g/d (mean: 68 g/d). Fructose substitution in some subgroups resulted in significantly but only slightly lowered fasting blood glucose (-0.14 mmol/L; 95% CI: -0.24, -0.036 mmol/L), HbA1c [-10 g/L (95% CI: -12.90, -7.10 g/L; impaired glucose tolerance) and -6 g/L (95% CI: -8.47, -3.53 g/L; normoglycemia)], triglycerides (-0.08 mmol/L; 95% CI: -0.14, -0.02 mmol/L), and body weight (-1.40 kg; 95% CI: -2.07, -0.74 kg). There was no effect on fasting blood insulin or blood lipids.Conclusions: The evidence suggests that the substitution of fructose for glucose or sucrose in food or beverages may be of benefit to individuals, particularly those with impaired glucose tolerance or type 2 diabetes. However, additional high-quality studies in these populations are required.
-
6.
Fructose replacement of glucose or sucrose in food or beverages lowers postprandial glucose and insulin without raising triglycerides: a systematic review and meta-analysis.
Evans, RA, Frese, M, Romero, J, Cunningham, JH, Mills, KE
The American journal of clinical nutrition. 2017;(2):506-518
-
-
Free full text
-
Abstract
Background: Conflicting evidence exists on the effects of fructose consumption in people with type 1 and type 2 diabetes mellitus. No systematic review has addressed the effect of isoenergetic fructose replacement of glucose or sucrose on peak postprandial glucose, insulin, and triglyceride concentrations.Objective: The objective of this study was to review the evidence for postprandial glycemic and insulinemic responses after isoenergetic replacement of either glucose or sucrose in foods or beverages with fructose.Design: We searched the Cochrane Library, MEDLINE, EMBASE, the WHO International Clinical Trials Registry Platform Search Portal, and clinicaltrials.gov The date of the last search was 26 April 2016. We included randomized controlled trials measuring peak postprandial glycemia after isoenergetic replacement of glucose, sucrose, or both with fructose in healthy adults or children with or without diabetes. The main outcomes analyzed were peak postprandial blood glucose, insulin, and triglyceride concentrations.Results: Replacement of either glucose or sucrose by fructose resulted in significantly lowered peak postprandial blood glucose, particularly in people with prediabetes and type 1 and type 2 diabetes. Similar results were obtained for insulin. Peak postprandial blood triglyceride concentrations did not significantly increase.Conclusions: Strong evidence exists that substituting fructose for glucose or sucrose in food or beverages lowers peak postprandial blood glucose and insulin concentrations. Isoenergetic replacement does not result in a substantial increase in blood triglyceride concentrations.
-
7.
Intravenous nutrients for preventing inadvertent perioperative hypothermia in adults.
Warttig, S, Alderson, P, Lewis, SR, Smith, AF
The Cochrane database of systematic reviews. 2016;(11):CD009906
-
-
Free full text
-
Abstract
BACKGROUND Inadvertent perioperative hypothermia (a drop in core temperature to below 36°C) occurs because normal temperature regulation is disrupted during surgery, mainly because of the effects of anaesthetic drugs and exposure of the skin for prolonged periods. Many different ways of maintaining body temperature have been proposed, one of which involves administration of intravenous nutrients during the perioperative period that may reduce heat loss by increasing metabolism, thereby increasing heat production. OBJECTIVES To assess the effectiveness of preoperative or intraoperative intravenous nutrients in preventing perioperative hypothermia and its complications during surgery in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; November 2015) in the Cochrane Library; MEDLINE, Ovid SP (1956 to November 2015); Embase, Ovid SP (1982 to November 2015); the Institute for Scientific Information (ISI) Web of Science (1950 to November 2015); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO host; 1980 to November 2015), as well as the reference lists of identified articles. We also searched the Current Controlled Trials website and ClincalTrials.gov. SELECTION CRITERIA Randomized controlled trials (RCTs) of intravenous nutrients compared with control or other interventions given to maintain normothermia in adults undergoing surgery. DATA COLLECTION AND ANALYSIS Two review authors extracted data and assessed risk of bias for each included trial, and a third review author checked details if necessary. We contacted some study authors to request additional information. MAIN RESULTS We included 14 trials (n = 565), 13 (n = 525) of which compared intravenous administration of amino acids to a control (usually saline solution or Ringer's lactate). The remaining trial (n = 40) compared intravenous administration of fructose versus a control. We noted much variation in these trials, which used different types of surgery, variable durations of surgery, and different types of participants. Most trials were at high or unclear risk of bias owing to inappropriate or unclear randomization methods, and to unclear participant and assessor blinding. This may have influenced results, but it is unclear how results might have been influenced.No trials reported any of our prespecified primary outcomes, which were risk of hypothermia and major cardiovascular events. Therefore, we decided to analyse data related to core body temperature instead as a primary outcome. It was not possible to conduct meta-analysis of data related to amino acid infusion for the 60-minute and 120-minute time points, as we observed significant statistical heterogeneity in the results. Some trials showed that higher temperatures were associated with amino acids, but not all trials reported statistically significant results, and some trials reported the opposite result, where the amino acid group had a lower core temperature than the control group. It was possible to conduct meta-analysis for six studies (n = 249) that provided data relating to the end of surgery. Amino acids led to a statistically significant increase in core temperature in comparison to those receiving control (MD = 0.46°C 95% CI 0.33 to 0.59; I2 0.0%; random-effects; moderate quality evidence).Three trials (n = 155) reported shivering as an outcome. Meta-analysis did not show a clear effect, and so it is uncertain whether amino acids reduce the risk of shivering (RR 0.36, 95% CI 0.13 to 1.00; I2 = 93%; random-effects model; very low-quality evidence). AUTHORS' CONCLUSIONS Intravenous amino acids may keep participants up to a half-degree C warmer than the control. This difference was statistically significant at the end of surgery, but not at other time points. However, the clinical importance of this finding remains unclear. It is also unclear whether amino acids have any effect on the risk of shivering and if intravenous nutrients confer any other benefits or harms, as high-quality data about these outcomes are lacking.
-
8.
Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies.
Jamnik, J, Rehman, S, Blanco Mejia, S, de Souza, RJ, Khan, TA, Leiter, LA, Wolever, TM, Kendall, CW, Jenkins, DJ, Sievenpiper, JL
BMJ open. 2016;(10):e013191
Abstract
BACKGROUND The prevalence of hyperuricemia and gout has increased in recent decades. The role of dietary fructose in the development of these conditions remains unclear. OBJECTIVE To conduct a systematic review and meta-analysis of prospective cohort studies investigating the association fructose consumption with incident gout and hyperuricemia. DESIGN MEDLINE, EMBASE and the Cochrane Library were searched (through September 2015). We included prospective cohort studies that assessed fructose consumption and incident gout or hyperuricemia. 2 independent reviewers extracted relevant data and assessed study quality using the Newcastle-Ottawa Scale. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS 2 studies involving 125 299 participants and 1533 cases of incident gout assessed the association between fructose consumption and incident gout over an average of 17 years of follow-up. No eligible studies assessed incident hyperuricemia as an outcome. Fructose consumption was associated with an increase in the risk of gout (RR=1.62, 95% CI 1.28 to 2.03, p<0.0001) with no evidence of interstudy heterogeneity (I2=0%, p=0.33) when comparing the highest (>11.8% to >11.9% total energy) and lowest (<6.9% to <7.5% total energy) quantiles of consumption. LIMITATIONS Despite a dose-response gradient, the overall quality of evidence as assessed by GRADE was low, due to indirectness. There were only two prospective cohort studies involving predominantly white health professionals that assessed incident gout, and none assessed hyperuricemia. CONCLUSIONS Fructose consumption was associated with an increased risk of developing gout in predominantly white health professionals. More prospective studies are necessary to understand better the role of fructose and its food sources in the development of gout and hyperuricemia. PROTOCOL REGISTRATION NUMBER NCT01608620.
-
9.
[Effects of fructose on triglycerides in individuals with diabetes: a Meta-analysis of experimental trials].
Xiang, X, Zhao, J, Zhu, J, Zhang, P, Wang, Z, Yang, Y
Wei sheng yan jiu = Journal of hygiene research. 2015;(3):470-8
Abstract
OBJECTIVE To assess the effects of fructose on the blood triglycerides, particularly examining treatment dose, duration, and control of food in individuals with diabetes. METHODS A systematic review and Meta-analysis of experimental clinical trials were conducted to investigate the effect of isocaloric fructose exchange for carbohydrate on triglycerides, total cholesterol. MedLine, EMBASE, The Cochrane Library, CMBdisc, CNKI (1970-2014), and some related journals were searched. Heterogeneity was assessed by 2 tests and quantified by I2. Meta-analysis was conducted by RevMan 5.3. RESULTS 15 reports (21 trials) met the eligibility criteria. Isocaloric fructose exchange for carbohydrate raised triglycerides under specific conditions in individuals with type 2 diabetes. A triglyceride-raising effect without heterogeneity was seen only in type 2 diabetes when the dose was ≥ 100 g fructose/d (WMD 0.17, 95% CI0.08 - 0.25, P < 0.0001). A triglyceride-raising effect with heterogeneity was seen in type 2 diabetes when the reference carbohydrate was starch (WMD 0.13, 95% CI 0.02 - 0.23 , P = 0.02). CONCLUSION Effect of fructose on the level of TG in type 2 diabetes patients is more sensitive than that in type 1 diabetes. The effect on triglycerides is dose dependent and depends on what kinds of carbohydrate is being exchanged with fructose.
-
10.
Association of fructose consumption and components of metabolic syndrome in human studies: a systematic review and meta-analysis.
Kelishadi, R, Mansourian, M, Heidari-Beni, M
Nutrition (Burbank, Los Angeles County, Calif.). 2014;(5):503-10
Abstract
OBJECTIVE The aim of this study was to review the current corpus of human studies to determine the association of various doses and durations of fructose consumption on metabolic syndrome. METHODS We searched human studies in PubMed, Scopus, Ovid, ISI Web of Science, Cochrane library, and Google Scholar databases. We searched for the following keywords in each paper: metabolic syndrome x, insulin resistance, blood glucose, blood sugar, fasting blood sugar, triglycerides, lipoproteins, HDL, cholesterol, LDL, blood pressure, mean arterial pressure, systolic blood pressure, diastolic blood pressure, hypertens*, waist circumference, and fructose, sucrose, high-fructose corn syrup, or sugar. RESULTS Overall, 3102 articles were gathered. We excluded studies on natural fructose content of foods, non-clinical trials, and trials in which fructose was recommended exclusively as sucrose or high-fructose corn syrup. Overall, 3069 articles were excluded. After review by independent reviewers, 15 studies were included in the meta-analysis. Fructose consumption was positively associated with increased fasting blood sugar (FBS; summary mean difference, 0.307; 95% confidence interval [CI], 0.149-0.465; P = 0.002), elevated triglycerides (TG; 0.275; 95% CI, 0.014-0.408; P = 0.002); and elevated systolic blood pressure (SBP; 0.297; 95% CI, 0.144-0.451; P = 0.002). The corresponding figure was inverse for high-density lipoprotein (HDL) cholesterol (-0.267; 95% CI, -0.406 to -0.128; P = 0.001). Significant heterogeneity existed between studies, except for FBS. After excluding studies that led to the highest effect on the heterogeneity test, the association between fructose consumption and TG, SBP, and HDL became non-significant. The results did not show any evidence of publication bias. No missing studies were identified with the trim-and-fill method. CONCLUSION Fructose consumption from industrialized foods has significant effects on most components of metabolic syndrome.