Fructose vs. glucose and metabolism: do the metabolic differences matter?
Sievenpiper,J.L., de Souza,R.J., Cozma,A.I., Chiavaroli,L., Ha,V. and Mirrahimi,A., Curr.Opin.Lipidol. 10.1097/MOL.0000000000000042
Objective: To update a series of systematic reviews and meta-analyses of controlled feeding trials to assess the cardiometabolic effects of fructose in isocaloric exchange for glucose.
Design: Systematic review with meta-analyses.
Main outcome measures: Examined effects of fructose on body weight, fasting lipids, postprandial TG, glycemic control. bp and uric acid, markers of NAFLD (fatty liver).
Results: 20 controlled feeding trials were examined (n=344). The median fructose dose was 165 g/d (25% E). Although all comparisons were isocaloric, 45% of trials provided excess energy, and 10% restricted energy. The majority of trials were deemed to be of low quality.
Pooled analyses of:
15 trials examined the effect on body weight, where fructose showed a significant reduction in body weight with no evidence of heterogeneity (SMD -0.61 95%CI -1.12,-0.11). In trials of excess energy, less weight gain was seen with fructose compared to glucose.
15 trials showed no evidence of adverse effect of fructose on fasting lipids, apart from total cholesterol. All end points were affected by heterogeneity, which was explained in part by dose. The results were the same when the meta-analysis was confined to trials in which diets provided excess energy.
3 trials showed that fructose increases ppTG compared to glucose with significant heterogeneity; 15 trials showed that fructose reduces glycated blood proteins with no evidence of heterogeneity; 7 trials showed that fructose reduced systolic bp and mean arterial pressure; 8 trials showed that fructose increases uric acid with evidence of significant heterogeneity; 7 trials showed that fructose has no adverse effects on markers of NAFLD with no evidence of heterogeneity.
Conclusions: Depending on the cardiometabolic endpoint in question, fructose has variable effects when replacing glucose. There is no justification to replace fructose with glucose in the diet.
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