Table 1.
Selected meta-analysis and systematic reviews having addressed the effects of fructose-containing caloric sweeteners on human health
| Publication | Review focus | Number of studies | Main results | Authors’ conclusions |
|---|---|---|---|---|
| Kelishadi, R et al., Nutrition 2014 [32] | Association between fructose consumption and components of the metabolic syndrome | 15 controlled mechanistic studies | Fructose consumption positively associated with fasting blood sugar, fasting blood triglycerides, and systolic blood pressure and negatively associated with HDL cholesterol | Fructose consumption from industrialized food has significant effects on most components of the metabolic syndrome |
| Wang et al., Atherosclerosis 2014 [34] | Effect of fructose on postprandial triglycerides | 14 mechanistic studies | Increased postprandial triglyceride concentration when fructose administered together with an excess caloric intake | Fructose in isocaloric exchange for other carbohydrate does not raise postprandial triglycerides. A small effect, however, cannot be ruled out under all isocaloric conditions. In contrast, there is a consistent and substantial postprandial triglyceride-raising effect of fructose seen in hypercaloric trials, in which fructose supplements background diets with excess energy at extreme doses |
| Te Morenga, L. et al., Am. J. Clin. Nutr. 2014 [49••] | Association between dietary sugars and lipids/blood pressure in adults and children | 40 mechanistic or intervention studies | Plasma triglyceride, total, and LDL cholesterol were higher, and HDL cholesterol was lower in individuals with higher sugar intake. The relationship between sugar intake and lipids was most marked when sugar was administered in weight-maintenance diet and body weight did not change. Sugar intake was associated with higher systolic and diastolic blood pressure | Dietary sugars influence blood lipids and blood pressure independent of effects on body weight |
| Cheungpasitporn, W et al., Nephrology 2014 [39•] | Association of sugar-sweetened beverages and chronic kidney disease | 2 prospective cohort studies and 3 cross-sectional or case-control studies | Relative risk of chronic kidney disease was significantly higher in subjects consuming sugar-sweetened beverages | This finding suggests that sugar-sweetened beverages may impact clinical management and primary prevention in high-risk patients |
| Jayalath, VH et al., J. Am. Coll. Nutr. 2014 [33] | Association between total fructose intake and risk of hypertension | 3 prospective cohort studies | No association between fructose intake and risk of hypertension | Total fructose intake is not associated with increased risk of hypertension |
| Chung, M et al., Am. J. Clin. Nutr 2014 [35] | Effects of fructose-containing caloric sweeteners and non-alcoholic fatty liver diseases and markers of liver health | 21 controlled mechanistic studies | Low levels of evidence that hypercaloric fructose increases intrahepatic fat content and plasma AST concentrations | The apparent association between liver health and fructose-containing caloric sweetener intake appears to be confounded by excessive energy intake |
| Xi, B et al., PLoS ONE 2014 [30] | Association between intake of fruit juices and incidence of type 2 diabetes | 4 prospective cohort studies | Relative risk of type 2 diabetes was significantly increased with consumption of sugar-sweetened fruit juices, but not with consumption of 100 % fruit juice | Our findings support dietary recommendations to limit sugar-sweetened beverages such as fruit juice with added sugar |
| Chiu S et al., Eur. J. Clin. Nutr. 2014 [36] | Effects of fructose on markers of non-alcoholic fatty liver diseases | 13 controlled mechanistic studies | Fructose in weight-maintenance diet had no effects; fructose in hypercaloric diet increased intrahepatic lipid concentration and blood ALT | Fructose providing excess energy at extreme doses raises intrahepatic fat and ALT, an effect that may be attributable to excess energy intake |
| Greenwood DC et al., Br. J. Nutr 2014 [51] | Association between sugar-sweetened and artificially sweetened soft drinks and type 2 diabetes in prospective cohorts | 11 epidemiological prospective studies | Relative risk increases by 120/330 ml/day with sugar- and by 113/330 ml/day with artificially sweetened drinks; the relationship is attenuated when data was adjusted for BMI | Findings indicate a positive association between sugar-sweetened soft drink intake and type 2 diabetes, attenuated by adjustment for BMI. The same association is observed with artificially sweetened beverages. Possible reverse causality |
| Malik, VS et al., Am. J. Clin. Nutr 2013 [31] | Effects of sugar-sweetened beverages on weight gain in adults and children | 32 (7 epidemiological prospective studies and 5 clinical intervention studies in children, 7 epidemiological prospective studies and 5 clinical intervention studies in adults) | In cohort studies, every daily serving of sugar-sweetened beverage is associated with body weight gain in children (+0.06 unit increase in BMI/year in children; +0.22 kg/year in adults). RCTs in children showed decreased body weight with reduced sugar-sweetened beverage consumption; RCTs in adults showed increased body weight with increased sugar-sweetened beverage consumption | Sugar-sweetened beverage consumption promotes weight gain in children and adults |
| Zhang, YH et al., J. Nutr 2013 [37] | Effects of very-high-fructose intake on total and LDL cholesterol | 24 mechanistic studies | Fructose dose dependently increases total and LDL cholesterol for daily intake >100 g; no effect for daily fructose intake <100 g. No effect on HDL cholesterol at any level of intake | Very-high-fructose intake (>100 g/day) increases total and LDL cholesterol |
| Pan A et al., Int. J. Obesity 2013 [40] | Effects of changes in water and sweetened beverage intake on long-term weight changes | 3 prospective cohort studies | Participants gained on average 1.5 kg/4 years; 1 cup/day increment in sugar-sweetened beverage associated with 0.36 kg body weight gain/4 years, 1 cup/day fruit juice with 0.22 kg/4 years body weight gain | Results suggest that increasing water intake in place of sugar-sweetened beverages is associated with lower long-term weight gain |
| Te Morenga, L et al., BMJ 2013 [48••] | Association between dietary sugars and body weight in adults and children | 38 prospective cohort studies and 30 mechanistic or intervention studies | In adults, increased sugar intake was associated with increased body weight and isoenergetic exchange of sugar with other carbohydrate with no change in body weight; in children, recommendation to decrease added sugar intake did not result in body weight changes, but in prospective cohort studies, the odds ratio for being overweight was significantly higher in the group with the highest intake of sugar-sweetened beverages | Among free-living people involving ad libitum diets, intake of added sugars or sugar-sweetened beverages is a determinant of body weight. Changes which occur with modifying intakes seem to be mediated via changes in energy intake |
| Cozma AI et al., Diab. Care 2012 [46••] | Effects of fructose on glycemic control in diabetes | 18 controlled mechanistic studies | Isocaloric exchange of fructose for other carbohydrates reduced glycated blood proteins | Isocaloric substitution of fructose for other carbohydrates improves long-term glycemic control in diabetes |
| Ha, V et al., Hypertension 2012 [45] | Effects of fructose on blood pressure | Mechanistic studies | Fructose intake in 13 trials with weight-maintenance diets decreased diastolic and mean blood pressure and had no effect on systolic blood pressure; fructose intake in 2 RCTs with hypercaloric diet had no effect on blood pressure | No adverse effect of isocaloric substitution of fructose for other carbohydrates on blood pressure |
| Sievenpiper, JL et al., Ann Int. Med. 2012 [43••] | Effects of fructose on body weight | 41 mechanistic and intervention studies | Fructose included in a weight-maintenance diet has no effect on body weight; fructose included in an hypercaloric diet significantly increases body weight | Fructose does not seem to cause weight gain when substituted for other carbohydrates in diets providing similar amounts of calories |
| Mattes, RD et al., Obesity Rev 2011 [41] | Effects of changes in sugar-sweetened beverage consumption on body weight | 12 intervention studies | 6 RCTs that added sugar-sweetened beverages showed dose-dependant increases in body weight; 6 RCTs that decreased sugar-sweetened beverages showed no effect on body mass index | The current evidence does not demonstrate conclusively that reducing sugar-sweetened beverages will reduce BMI levels |
| Malik, VS et al., Diab. Care 2010 [50] | Association between sugar-sweetened beverage intake and risk of metabolic syndrome and diabetes in prospective cohort studies | 11 epidemiological prospective studies | In 8 prospective studies, the participants in the highest quantile for sugar-sweetened beverage consumption (1–2 servings/day) had a 28 % increased risk of developing diabetes. In 3 cohort studies, relative risk for developing the metabolic syndrome was increased by 20 % in high consumers | In addition to weight gain, higher consumption of sugar-sweetened beverages is associated with the development of metabolic syndrome and type 2 diabetes |
| Sievenpiper JL et al., Diab. Care 2009 [47] | Effects of fructose on blood lipids in subjects with type 2 diabetes | 16 controlled mechanistic studies | Fructose replacing starch increased blood triglyceride when dose >60 g/day or follow-up was <4 weeks | Threshold dose for fructose increasing blood triglyceride in subjects with type 2 diabetes is 60 g/day |
| Forshee, RA et al., Am. J. Clin. Nutr 2009 [52] | Association between sugar-sweetened beverage intake and body mass index in children and adolescents | 8 epidemiologic prospective studies and 2 clinical intervention trials | No significant association between sugar-sweetened beverage consumption and BMI | The association between sugar-sweetened beverages consumption and body mass index is zero based on scientific evidence as of 2009 |
| Livesey, G et al., Am J Clin Nutr 2008 [21] | Effects of fructose on glycated hemoglobin (HbA1c) and blood triglycerides | 42 mechanistic and intervention studies | Lower HbA1c with fructose intake <90 g/day; no significant effects on fasting blood triglycerides for fructose intake <100 g/day; no effect on postprandial blood triglyceride for intake <50 g/day | Fructose intake from 0 to 90 g/day has a beneficial effect on HbA1c; significant effects on blood triglycerides are not observed unless fructose intake >50 g/day |