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

Rebecca A Evans, Michael Frese, Julio ROMERO ZAPATA, Judy H Cunningham, Kerry MILLS

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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.

Original languageEnglish
Pages (from-to)519-529
Number of pages11
JournalAmerican Journal of Clinical Nutrition
Volume106
Issue number2
DOIs
Publication statusPublished - 1 Aug 2017

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Food and Beverages
Fructose
Sucrose
Blood Glucose
Meta-Analysis
Fasting
Triglycerides
Insulin
Glucose
Glucose Intolerance
Type 2 Diabetes Mellitus
Body Weight
Health Services Needs and Demand
Glycosylated Hemoglobin A
MEDLINE
Lipoproteins
Libraries
Registries
Randomized Controlled Trials
Clinical Trials

Cite this

@article{6248c42bc523459e9c8a2975307787a7,
title = "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",
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.",
keywords = "sugar replacement, fructose, glucose, sucrose, insulin, triglycerides, diabetes, body weight, Sugar replacement, Sucrose, Body weight, Triglycerides, Glucose, Insulin, Fructose, Diabetes, Glucose Intolerance/blood, Humans, Insulin/blood, Male, Sucrose/pharmacology, Female, Beverages, Body Weight/drug effects, Diabetes Mellitus, Type 2/blood, Blood Glucose/metabolism, Fructose/pharmacology, Feeding Behavior, Diet, Glucose/pharmacology, Triglycerides/blood, Glycated Hemoglobin A/metabolism",
author = "Evans, {Rebecca A} and Michael Frese and {ROMERO ZAPATA}, Julio and Cunningham, {Judy H} and Kerry MILLS",
note = "{\circledC} 2017 American Society for Nutrition.",
year = "2017",
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day = "1",
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pages = "519--529",
journal = "The Journal of clinical nutrition",
issn = "0002-9165",
publisher = "American Society for Nutrition",
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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 ZAPATA, Julio

AU - Cunningham, Judy H

AU - MILLS, Kerry

N1 - © 2017 American Society for Nutrition.

PY - 2017/8/1

Y1 - 2017/8/1

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.

AB - 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.

KW - sugar replacement

KW - fructose

KW - glucose

KW - sucrose

KW - insulin

KW - triglycerides

KW - diabetes

KW - body weight

KW - Sugar replacement

KW - Sucrose

KW - Body weight

KW - Triglycerides

KW - Glucose

KW - Insulin

KW - Fructose

KW - Diabetes

KW - Glucose Intolerance/blood

KW - Humans

KW - Insulin/blood

KW - Male

KW - Sucrose/pharmacology

KW - Female

KW - Beverages

KW - Body Weight/drug effects

KW - Diabetes Mellitus, Type 2/blood

KW - Blood Glucose/metabolism

KW - Fructose/pharmacology

KW - Feeding Behavior

KW - Diet

KW - Glucose/pharmacology

KW - Triglycerides/blood

KW - Glycated Hemoglobin A/metabolism

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UR - http://www.mendeley.com/research/chronic-fructose-substitution-glucose-sucrose-food-beverages-little-effect-fasting-blood-glucose-ins-1

U2 - 10.3945/ajcn.116.145169

DO - 10.3945/ajcn.116.145169

M3 - Article

VL - 106

SP - 519

EP - 529

JO - The Journal of clinical nutrition

JF - The Journal of clinical nutrition

SN - 0002-9165

IS - 2

ER -