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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.
Am J Clin Nutr 2017; 106(2):519-529AJ

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.

Authors+Show Affiliations

Health Research Institute.Health Research Institute. Faculty of Education, Science, Technology, and Mathematics, and.Department of Software Engineering and Artificial Intelligence, University of Canberra, Canberra, Australia; and.Formerly of Risk Assessment Chemical Safety and Nutrition, Food Standards Australia New Zealand, Canberra, Australia.Health Research Institute, kerry.mills@canberra.edu.au. Faculty of Education, Science, Technology, and Mathematics, and.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28592603

Citation

Evans, Rebecca A., et al. "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." The American Journal of Clinical Nutrition, vol. 106, no. 2, 2017, pp. 519-529.
Evans RA, Frese M, Romero J, et al. 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. Am J Clin Nutr. 2017;106(2):519-529.
Evans, R. A., Frese, M., Romero, J., Cunningham, J. H., & Mills, K. E. (2017). 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. The American Journal of Clinical Nutrition, 106(2), pp. 519-529. doi:10.3945/ajcn.116.145169.
Evans RA, et al. 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. Am J Clin Nutr. 2017;106(2):519-529. PubMed PMID: 28592603.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Evans,Rebecca A, AU - Frese,Michael, AU - Romero,Julio, AU - Cunningham,Judy H, AU - Mills,Kerry E, Y1 - 2017/06/07/ PY - 2016/09/16/received PY - 2017/05/01/accepted PY - 2017/6/9/pubmed PY - 2017/8/17/medline PY - 2017/6/9/entrez KW - body weight KW - diabetes KW - fructose KW - glucose KW - insulin KW - sucrose KW - sugar replacement KW - triglycerides SP - 519 EP - 529 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 106 IS - 2 N2 - 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. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/28592603/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_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.116.145169 DB - PRIME DP - Unbound Medicine ER -