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Gonzalez JT. Are all sugars equal? Role of the food source in physiological responses to sugars with an emphasis on fruit and fruit juice. Eur J Nutr 2024:10.1007/s00394-024-03365-3. [PMID: 38492022 DOI: 10.1007/s00394-024-03365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 03/18/2024]
Abstract
High (free) sugar intakes can increase self-reported energy intake and are associated with unfavourable cardiometabolic health. However, sugar source may modulate the effects of sugars due to several mechanisms including the food matrix. The aim of this review was to assess the current state of evidence in relation to food source effects on the physiological responses to dietary sugars in humans relevant to cardiometabolic health. An additional aim was to review potential mechanisms by which food sources may influence such responses. Evidence from meta-analyses of controlled intervention trials was used to establish the balance of evidence relating to the addition of sugars to the diet from sugar-sweetened beverages, fruit juice, honey and whole fruit on cardiometabolic outcomes. Subsequently, studies which have directly compared whole fruit with fruit juices, or variants of fruit juices, were discussed. In summary, the sources of sugars can impact physiological responses, with differences in glycaemic control, blood pressure, inflammation, and acute appetite. Longer-term effects and mechanisms require further work, but initial evidence implicates physical structure, energy density, fibre, potassium and polyphenol content, as explanations for some of the observed responses.
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Affiliation(s)
- Javier T Gonzalez
- Centre for Nutrition, Exercise and Metabolism, University of Bath, Bath, UK.
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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Buziau AM, Scheijen JL, Stehouwer CD, Schalkwijk CG, Brouwers MC. Effects of fructose added to an oral glucose tolerance test on plasma glucose excursions in healthy adults. Metabol Open 2023; 18:100245. [PMID: 37251289 PMCID: PMC10209703 DOI: 10.1016/j.metop.2023.100245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background and objective Previous experimental studies have shown that fructose interacts with glucose metabolism by increasing hepatic glucose uptake. However, human studies investigating the effects of small ('catalytic') amounts of fructose, added to an oral glucose load, on plasma glucose levels remain inconclusive. The aim of this study, therefore, was to repeat and extend these previous studies by examining the plasma glucose response during a 75 g oral glucose tolerance test (OGTT) with the addition of different doses of fructose. Methods Healthy adults (n = 13) received an OGTT without addition of fructose and OGTTs with addition of different doses of fructose (1, 2, 5, 7.5 and 15 g) in a random order, on six separate occasions. Plasma glucose levels were measured every 15 min for 120 min during the study. Findings The plasma glucose incremental area under the curve (iAUC) of the OGTT without addition of fructose was not significantly different from any OGTT with fructose (p ≥ 0.2 for all fructose doses). Similar results were observed when these data were clustered with data from a similar, previous study (pooled mean difference: 10.6; 95%CI: 45.0; 23.8 for plasma glucose iAUC of the OGTT without addition of fructose versus an OGTT with 5 g fructose; fixed-effect meta-analysis, n = 38). Of interest, serum fructose increased from 4.8 μmol/L (interquartile range: 4.1-5.9) at baseline to 5.3 μmol/L (interquartile range: 4.8-7.5) at T = 60 min during an OGTT without addition of fructose (p = 0.002). Conclusion Low doses of fructose added to an OGTT do not affect plasma glucose levels in healthy adults. The role of endogenous fructose production, as a potential explanation of these null-findings, deserves further investigation.
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Affiliation(s)
- Amée M. Buziau
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Laboratory for Metabolism and Vascular Medicine, Maastricht University, Maastricht, the Netherlands
| | - Jean L.J.M. Scheijen
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Laboratory for Metabolism and Vascular Medicine, Maastricht University, Maastricht, the Netherlands
| | - Coen D.A. Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Casper G. Schalkwijk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Laboratory for Metabolism and Vascular Medicine, Maastricht University, Maastricht, the Netherlands
| | - Martijn C.G.J. Brouwers
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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Visuthranukul C, Sampatanukul P, Aroonparkmongkol S, Sirimongkol P, Chomtho S. Glycemic index and glycemic load of common fruit juices in Thailand. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:5. [PMID: 35227323 PMCID: PMC8886830 DOI: 10.1186/s41043-022-00284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background The glycemic index (GI) reflects body responses to different carbohydrate-rich foods. Generally, it cannot be simply predicted from the composition of the food but needs in vivo testing. Methods Healthy adult volunteers with normal body mass index were recruited. Each volunteer was asked to participate in the study center twice in the first week to consume the reference glucose (50 g) and once a week thereafter to consume the study fruit juices in a random order. The study fruit juices were Florida orange juice, Tangerine orange juice, Blackcurrant mixed juice, and Veggie V9 orange carrot juice which were already available on the market. The serving size of each fruit juice was calculated to provide 50 g of glycemic carbohydrate. The fasting and subsequent venous blood samplings were obtained through the indwelling venous catheters at 0, 15, 30, 45, 60, 90, and 120 min after the test drink consumption and immediately sent for plasma glucose and insulin. GI and insulin indices were calculated from the incremental area under the curve of postprandial glucose of the test drink divided by the reference drink. Glycemic load (GL) was calculated from the GI multiplied by carbohydrate content in the serving size. Results A total of 12 volunteers participated in the study. Plasma glucose and insulin peaked at 30 min after the drink was consumed, and then started to decline at 120 min. Tangerine orange juice had the lowest GI (34.1 ± 18.7) and GL (8.1 g). Veggie V9 had the highest GI (69.6 ± 43.3) but it was in the third GL rank (12.4 g). The insulin responses correlated well with the GI. Fructose to glucose ratio was inversely associated with GI and insulin responses for all study fruit juices. Fiber contents in the study juices did not correlate with glycemic and insulin indices. Conclusions The GIs of fruit juices were varied but consistently showed a positive correlation with insulin indices. Fruit juices with low GI are a healthier choice for people with diabetes as well as individuals who want to stay healthy since it produces more subtle postprandial glucose and insulin responses.
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Sano H, Nakamura A, Yamane M, Niwa H, Nishimura T, Araki K, Takemoto K, Ishiguro KI, Aoki H, Kato Y, Kojima M. The polyol pathway is an evolutionarily conserved system for sensing glucose uptake. PLoS Biol 2022; 20:e3001678. [PMID: 35687590 PMCID: PMC9223304 DOI: 10.1371/journal.pbio.3001678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/23/2022] [Accepted: 05/17/2022] [Indexed: 01/20/2023] Open
Abstract
Cells must adjust the expression levels of metabolic enzymes in response to fluctuating nutrient supply. For glucose, such metabolic remodeling is highly dependent on a master transcription factor ChREBP/MondoA. However, it remains elusive how glucose fluctuations are sensed by ChREBP/MondoA despite the stability of major glycolytic pathways. Here, we show that in both flies and mice, ChREBP/MondoA activation in response to glucose ingestion involves an evolutionarily conserved glucose-metabolizing pathway: the polyol pathway. The polyol pathway converts glucose to fructose via sorbitol. It has been believed that this pathway is almost silent, and its activation in hyperglycemic conditions has deleterious effects on human health. We show that the polyol pathway regulates the glucose-responsive nuclear translocation of Mondo, a Drosophila homologue of ChREBP/MondoA, which directs gene expression for organismal growth and metabolism. Likewise, inhibition of the polyol pathway in mice impairs ChREBP’s nuclear localization and reduces glucose tolerance. We propose that the polyol pathway is an evolutionarily conserved sensing system for glucose uptake that allows metabolic remodeling. The polyol pathway, which converts glucose to fructose via sorbitol, was thought to be largely silent, and only the negative effects of its activation were known. This study reveals that the polyol pathway is involved in glucose-responsive activation of Mondo/ChREBP-mediated metabolic remodeling in both mice and flies.
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Affiliation(s)
- Hiroko Sano
- Department of Molecular Genetics, Institute of Life Science, Kurume University, Kurume, Fukuoka, Japan
- * E-mail:
| | - Akira Nakamura
- Department of Germline Development, Institute of Molecular Embryology and Genetics, and Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Mariko Yamane
- Department of Pluripotent Stem Cell Biology, Institute of Molecular Embryology and Genetics, and Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Hitoshi Niwa
- Department of Pluripotent Stem Cell Biology, Institute of Molecular Embryology and Genetics, and Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Takashi Nishimura
- Laboratory of Metabolic Regulation and Genetics, Institute for Molecular and Cellular Regulation, Gunma University, Maebashi, Gunma, Japan
| | - Kimi Araki
- Institute of Resource Development and Analysis, Kumamoto University, Kumamoto, Kumamoto, Japan
- Center for Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Kazumasa Takemoto
- Institute of Resource Development and Analysis, Kumamoto University, Kumamoto, Kumamoto, Japan
- Department of Chromosome Biology, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Kei-ichiro Ishiguro
- Department of Chromosome Biology, Institute of Molecular Embryology and Genetics, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Hiroki Aoki
- Cardiovascular Research Institute, Kurume University, Kurume, Fukuoka, Japan
| | - Yuzuru Kato
- Mammalian Development Laboratory, Department of Gene Function and Phenomics, National Institute of Genetics, Mishima, Shizuoka, Japan
- Department of Genetics, SOKENDAI, Mishima, Shizuoka, Japan
| | - Masayasu Kojima
- Department of Molecular Genetics, Institute of Life Science, Kurume University, Kurume, Fukuoka, Japan
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Eckstein ML, Brockfeld A, Haupt S, Schierbauer JR, Zimmer RT, Wachsmuth N, Zunner B, Zimmermann P, Obermayer-Pietsch B, Moser O. Acute Metabolic Responses to Glucose and Fructose Supplementation in Healthy Individuals: A Double-Blind Randomized Crossover Placebo-Controlled Trial. Nutrients 2021; 13:nu13114095. [PMID: 34836350 PMCID: PMC8620063 DOI: 10.3390/nu13114095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to investigate the impact of glucose (Glu), fructose (Fru), glucose and fructose (GluFru) and sucralose on blood glucose response in healthy individuals. Fifteen healthy individuals (five females, age of 25.4 ± 2.5 years, BMI of 23.7 ± 1.7 kg/m2 with a body mass (BM) of 76.3 ± 12.3 kg) participated in this double-blind randomized crossover placebo-controlled trial. Participants received a mixture of 300 mL of water with 1 g/kg BM of Glu, 1 g/kg BM of Fru, 0.5 g/kg BM of GluFru (each), and 0.2 g sucralose as a placebo. Peak BG values Glu were reached after 40 ± 13 min (peak BG: 141 ± 20 mg/dL), for Fru after 36 ± 22 min (peak BG: 98 ± 7 mg/dL), for GluFru after 29 ± 8 min (BG 128 ± 18 mg/dL), and sucralose after 34 ± 27 min (peak BG: 83 ± 5 mg/dL). Significant differences regarding the time until peak BG were found only between Glu and GluFru supplementation (p = 0.02). Peak blood glucose levels were significantly lower following the ingestion of Fru compared to the supplementation of Glu and GluFru (p < 0.0001) while Glu and GluFru supplementation showed no difference in peak values (p = 0.23). All conditions led to a significantly higher peak BG value compared to sucralose (p < 0.0001). Blood lactate increased in Glu (p = 0.002), Fru and GluFru (both p < 0.0001), whereas sucralose did not increase compared to the baseline (p = 0.051). Insulin levels were significantly higher in all conditions at peak compared to sucralose (p < 0.0001). The findings of this study prove the feasibility of combined carbohydrate supplementations for many applications in diabetic or healthy exercise cohorts.
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Affiliation(s)
- Max L. Eckstein
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
| | - Antonia Brockfeld
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
| | - Sandra Haupt
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
| | - Janis R. Schierbauer
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
| | - Rebecca T. Zimmer
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
| | - Nadine Wachsmuth
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
| | - Beate Zunner
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
| | - Paul Zimmermann
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Medical University of Graz, 8036 Graz, Austria;
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (M.L.E.); (A.B.); (S.H.); (J.R.S.); (R.T.Z.); (N.W.); (B.Z.); (P.Z.)
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
- Correspondence: ; Tel.: +49-(0)921-55-3465
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Lu X, Lu J, Fan Z, Liu A, Zhao W, Wu Y, Zhu R. Both Isocarbohydrate and Hypercarbohydrate Fruit Preloads Curbed Postprandial Glycemic Excursion in Healthy Subjects. Nutrients 2021; 13:nu13072470. [PMID: 34371978 PMCID: PMC8308803 DOI: 10.3390/nu13072470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the impact of fruit preloads on the acute postprandial glycemic response (PGR) and satiety response of a rice meal in healthy female subjects based on iso-carbohydrate (IC) and hyper-carbohydrate (HC) contents, respectively. The IC test meals including (1) rice preload (R + 35R), (2) orange preload (O + 35R), (3) apple preload (A + 35R) and (4) pear preload (P + 35R), contained 50.0 g available carbohydrates (AC) where the preload contributed 15.0 g and rice provided 35.0 g. The HC meals included (1) orange preload (O + 50R), (2) apple preload (A+50R) and (3) pear preload (P + 50R), each containing 65.0 g AC, where the fruits contributed 15.0 g and rice provided 50.0 g. Drinking water 30 min before the rice meal was taken as reference (W + 50R). All the preload treatments, irrespective of IC or HC meals, resulted in remarkable reduction (p < 0.001) in terms of incremental peak glucose (IPG) and the maximum amplitude of glycemic excursion in 180 min (MAGE0–180), also a significant decrease (p < 0.05) in the area of PGR contributed by per gram of AC (AAC), compared with the W + 50R. Apple elicited the lowest PGR among all test meals, as the A + 35R halved the IPG and slashed the incremental area under the curve in 180 min (iAUC0–180) by 45.7%, while the A + 50R reduced the IPG by 29.7%, compared with the W + 50R. All the preload meals and the reference meal showed comparable self-reported satiety in spite of the difference in AC. In conclusion, pre-meal consumption of three fruits effectively curbed post-meal glycemia even in the case of a 30% extra carbohydrate load.
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Affiliation(s)
- Xuejiao Lu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (X.L.); (J.L.); (A.L.); (W.Z.); (Y.W.); (R.Z.)
| | - Jiacan Lu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (X.L.); (J.L.); (A.L.); (W.Z.); (Y.W.); (R.Z.)
| | - Zhihong Fan
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (X.L.); (J.L.); (A.L.); (W.Z.); (Y.W.); (R.Z.)
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100083, China
- Correspondence: ; Tel.: +86-10-62737717
| | - Anshu Liu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (X.L.); (J.L.); (A.L.); (W.Z.); (Y.W.); (R.Z.)
| | - Wenqi Zhao
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (X.L.); (J.L.); (A.L.); (W.Z.); (Y.W.); (R.Z.)
| | - Yixue Wu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (X.L.); (J.L.); (A.L.); (W.Z.); (Y.W.); (R.Z.)
| | - Ruixin Zhu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China; (X.L.); (J.L.); (A.L.); (W.Z.); (Y.W.); (R.Z.)
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Khorshidian N, Shadnoush M, Zabihzadeh Khajavi M, Sohrabvandi S, Yousefi M, Mortazavian AM. Fructose and high fructose corn syrup: are they a two-edged sword? Int J Food Sci Nutr 2021; 72:592-614. [PMID: 33499690 DOI: 10.1080/09637486.2020.1862068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
High-fructose syrups are used as sugar substitutes due to their physical and functional properties. High fructose corn syrup (HFCS) is used in bakery products, dairy products, breakfast cereals and beverages, but it has been reported that there might be a direct relationship between high fructose intake and adverse health effects such as obesity and the metabolic syndrome. Thus, fructose has recently received much attention, most of which was negative. Although studies have indicated that there might be a correlation between high fructose-rich diet and several adverse effects, however, the results of these studies cannot be certainly generalised to the effects of HFCS; because they have investigated pure fructose at very high concentrations in measurement of metabolic upsets. This review critically considered the advantages and possible disadvantages of HFCS application and consumption in food industry, as a current challenging issue between nutritionists and food technologists.
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Affiliation(s)
- Nasim Khorshidian
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Mahdi Shadnoush
- Department of Clinical Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Zabihzadeh Khajavi
- Student Research Committee, Department of Food Technology, Faculty of Nutrition Sciences and Food Technology/National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Sohrabvandi
- Department of Food Technology Research, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Yousefi
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Amir M Mortazavian
- Food Safety Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Dos Santos Lima É, Souto DL, Rodacki M, Pereira JRD, Zajdenverg L, Rosado EL. Metabolic and Appetite Effects of Fructose and Glucose in Subjects with Type 1 Diabetes: A Randomized Crossover Clinical Trial. Curr Diabetes Rev 2021; 17:e113020188536. [PMID: 33261542 DOI: 10.2174/1573399816666201201092334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fructose has been widely used for producing lower post-infusion glucose increase than other carbohydrates, but it seems that it promotes an increase in post-infusion triglycerides. OBJECTIVE The present study investigated the effects of fructose and glucose in metabolic variables and appetite sensations in patients with type 1 diabetes mellitus (T1DM). METHODS This is a single-blind, randomized, and crossover study (washout of 1-5 weeks), which evaluated 16 adult T1DM patients, accompanied at University Hospital. After eight hours of overnight fasting, there was an assessment of capillary blood glucose, anthropometric variables, appetite sensations, and laboratory tests (glycemia, lipemia, leptin and glucagon) were conducted. Subsequently, they received 200mL of solutions with water and 75g of crystal fructose or glucose. Appetite sensations and capillary blood glucose were evaluated in different post-infusion times. Blood was drawn after 180 minutes for the laboratory tests. RESULTS Blood glucose increased after the intake of both solutions, but glucose induced a higher elevation. None of them increased triglycerides or glucagon. Glucagon maintenance was similar among the solutions. Furthermore, both solutions reduced leptin and increased fullness, but only fructose increased the lack of interest in eating sweets. CONCLUSION Fructose induced a smaller increase in postprandial blood glucose than glucose, without changes in triglycerides and glucagon. In addition, leptin levels and appetite sensations were similar to glucose. Other studies are needed in order to confirm these findings, especially in the long term, so that their use becomes really reliable.
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Affiliation(s)
- Érika Dos Santos Lima
- Nutrition Institute Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| | - Débora Lopes Souto
- Nutrition Institute Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| | - Melanie Rodacki
- Medicine Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| | | | - Lenita Zajdenverg
- Medicine Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
| | - Eliane Lopes Rosado
- Nutrition Institute Josue de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
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Braunstein CR, Noronha JC, Khan TA, Mejia SB, Wolever TMS, Josse RG, Kendall CWC, Sievenpiper JL. Effect of fructose and its epimers on postprandial carbohydrate metabolism: A systematic review and meta-analysis. Clin Nutr 2020; 39:3308-3318. [DOI: 10.1016/j.clnu.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/25/2020] [Accepted: 03/01/2020] [Indexed: 12/14/2022]
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Camps SG, Koh HR, Wang NX, Henry CJ. A fructose-based meal challenge to assess metabotypes and their metabolic risk profile: A randomized, crossover, controlled trial. Nutrition 2020; 78:110799. [PMID: 32544846 DOI: 10.1016/j.nut.2020.110799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The first aim of this study was to determine the metabolic type of individuals based on the postprandial metabolic response after the ingestion of a meal challenge that was high protein and either high glucose (high GI) or fructose (low GI). The second aim was to compare the baseline characteristics between the different metabolic types (metabotypes). The third aim was to assess whether the inclusion of fructose or glucose in a high-protein breakfast modulated the glucose, insulin, and TG response over a 4-h period. METHODS The study included 46 Asian women with a body mass index between 17 and 28 kg/m2 in a randomized crossover design. Metabolic typing was based on the assessment of the postprandial glycemic, insulin and triacylglycerol (TG) response after the ingestion of two high-protein meal challenges either high in fructose or glucose. Baseline characteristics were compared between the different metabolic types. Baseline and 4-h postprandial blood samples were collected and glucose, insulin, and TG levels were analyzed. Cluster analysis was used to phenotype the participants in distinct groups. Baseline characteristics including anthropometry, glycemic, and lipid profiles and resting metabolic rate were compared among the metabolic types. RESULTS Cluster analysis revealed that women could be grouped into three metabolic types based on postprandial glucose, insulin, and TG response after the fructose meal challenge: cluster 1 with an average glucose + high TG response (highTG; n = 12), cluster 2 with a high glucose + average TG response (highGLU; n = 8), and cluster 3 with an average glucose + average TG response (Avg; n = 26). Post hoc analysis revealed significantly greater waist-to-hip ratio and a worse lipid profile for the highTG cluster and a higher fasting blood glucose, body mass index, fat percentage, and hip circumference in the highGLU cluster. CONCLUSIONS Three metabolic types with a distinct metabolic response could be distinguished after a high fructose meal. The results suggest a different risk profile and may indicate why some people develop diabetes in an obesogenic environment. Improved metabolic-type assessments will enable us to develop and optimize nutritional and medical interventions for individuals with differing diabetes risk.
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Affiliation(s)
- Stefan Gerardus Camps
- Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research and National University Health System, Singapore
| | - Huann Rong Koh
- Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research and National University Health System, Singapore
| | - Nan Xin Wang
- Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research and National University Health System, Singapore
| | - Christiani Jeyakumar Henry
- Singapore Institute of Food and Biotechnology Innovation, Agency for Science, Technology and Research and National University Health System, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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11
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Dewdney B, Roberts A, Qiao L, George J, Hebbard L. A Sweet Connection? Fructose's Role in Hepatocellular Carcinoma. Biomolecules 2020; 10:E496. [PMID: 32218179 PMCID: PMC7226025 DOI: 10.3390/biom10040496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma is one of few cancer types that continues to grow in incidence and mortality worldwide. With the alarming increase in diabetes and obesity rates, the higher rates of hepatocellular carcinoma are a result of underlying non-alcoholic fatty liver disease. Many have attributed disease progression to an excess consumption of fructose sugar. Fructose has known toxic effects on the liver, including increased fatty acid production, increased oxidative stress, and insulin resistance. These effects have been linked to non-alcoholic fatty liver (NAFLD) disease and a progression to non-alcoholic steatohepatitis (NASH). While the literature suggests fructose may enhance liver cancer progression, the precise mechanisms in which fructose induces tumor formation remains largely unclear. In this review, we summarize the current understanding of fructose metabolism in liver disease and liver tumor development. Furthermore, we consider the latest knowledge of cancer cell metabolism and speculate on additional mechanisms of fructose metabolism in hepatocellular carcinoma.
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Affiliation(s)
- Brittany Dewdney
- Molecular and Cell Biology, and The Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville QLD 4811, Australia; (B.D.); (A.R.)
| | - Alexandra Roberts
- Molecular and Cell Biology, and The Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville QLD 4811, Australia; (B.D.); (A.R.)
| | - Liang Qiao
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney NSW 2145, Australia; (L.Q.); (J.G.)
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney NSW 2145, Australia; (L.Q.); (J.G.)
| | - Lionel Hebbard
- Molecular and Cell Biology, and The Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville QLD 4811, Australia; (B.D.); (A.R.)
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney NSW 2145, Australia; (L.Q.); (J.G.)
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12
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Lende TH, Austdal M, Bathen TF, Varhaugvik AE, Skaland I, Gudlaugsson E, Egeland NG, Lunde S, Akslen LA, Jonsdottir K, Janssen EAM, Søiland H, Baak JPA. Metabolic consequences of perioperative oral carbohydrates in breast cancer patients - an explorative study. BMC Cancer 2019; 19:1183. [PMID: 31801490 PMCID: PMC6894229 DOI: 10.1186/s12885-019-6393-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background The metabolic consequences of preoperative carbohydrate load in breast cancer patients are not known. The present explorative study investigated the systemic and tumor metabolic changes after preoperative per-oral carbohydrate load and their influence on tumor characteristics and survival. Methods The study setting was on university hospital level with primary and secondary care functions in south-west Norway. Serum and tumor tissue were sampled from a population-based cohort of 60 patients with operable breast cancer who were randomized to either per-oral carbohydrate load (preOp™; n = 25) or standard pre-operative fasting (n = 35) before surgery. Magnetic resonance (MR) metabolomics was performed on serum samples from all patients and high-resolution magic angle spinning (HR-MAS) MR analysis on 13 tumor samples available from the fasting group and 16 tumor samples from the carbohydrate group. Results Fourteen of 28 metabolites were differently expressed between fasting and carbohydrate groups. Partial least squares discriminant analysis showed a significant difference in the metabolic profile between the fasting and carbohydrate groups, compatible with the endocrine effects of insulin (i.e., increased serum-lactate and pyruvate and decreased ketone bodies and amino acids in the carbohydrate group). Among ER-positive tumors (n = 18), glutathione was significantly elevated in the carbohydrate group compared to the fasting group (p = 0.002), with a positive correlation between preoperative S-insulin levels and the glutathione content in tumors (r = 0.680; p = 0.002). In all tumors (n = 29), glutamate was increased in tumors with high proliferation (t-test; p = 0.009), independent of intervention group. Moreover, there was a positive correlation between tumor size and proliferation markers in the carbohydrate group only. Patients with ER-positive / T2 tumors and high tumor glutathione (≥1.09), high S-lactate (≥56.9), and high S-pyruvate (≥12.5) had inferior clinical outcomes regarding relapse-free survival, breast cancer-specific survival, and overall survival. Moreover, Integrated Pathway Analysis (IPA) in serum revealed activation of five major anabolic metabolic networks contributing to proliferation and growth. Conclusions Preoperative carbohydrate load increases systemic levels of lactate and pyruvate and tumor levels of glutathione and glutamate in ER-positive patients. These biological changes may contribute to the inferior clinical outcomes observed in luminal T2 breast cancer patients. Trial of registration ClinicalTrials.gov; NCT03886389. Retrospectively registered March 22, 2019.
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Affiliation(s)
- Tone Hoel Lende
- Department of Breast & Endocrine Surgery, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway. .,Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Jonas Lies vei 87, N-5012, Bergen, Norway.
| | - Marie Austdal
- Department of Research, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway.,Department of Pathology, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway
| | - Tone Frost Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Elin Varhaugvik
- Department of Pathology, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway.,Department of Pathology, Helse Møre og Romsdal, Ålesund, Norway
| | - Ivar Skaland
- Department of Pathology, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway
| | - Einar Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway
| | - Nina G Egeland
- Department of Pathology, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Technology, University of Stavanger, P.O. Box 8600 Forus, N-4036, Stavanger, Norway
| | - Siri Lunde
- Department of Breast & Endocrine Surgery, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway
| | - Lars A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Jonas Lies vei 87, N-5012, Bergen, Norway
| | - Kristin Jonsdottir
- Department of Research, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway
| | - Emiel A M Janssen
- Department of Pathology, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway.,Department of Chemistry, Bioscience and Environmental Technology, University of Stavanger, P.O. Box 8600 Forus, N-4036, Stavanger, Norway
| | - Håvard Søiland
- Department of Breast & Endocrine Surgery, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Jonas Lies vei 87, N-5012, Bergen, Norway
| | - Jan P A Baak
- Department of Pathology, Stavanger University Hospital, Helse Stavanger HF, P.O. Box 8100, N-4068, Stavanger, Norway.,Dr. Med. Jan Baak AS, Risavegen 66, N-4056, Tananger, Norway
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13
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Lu J, Zhao W, Wang L, Fan Z, Zhu R, Wu Y, Zhou Y. Apple Preload Halved the Postprandial Glycaemic Response of Rice Meal on in Healthy Subjects. Nutrients 2019; 11:nu11122912. [PMID: 31810219 PMCID: PMC6950014 DOI: 10.3390/nu11122912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022] Open
Abstract
This study aimed to investigate the possible glycemic effect of apple preload on acute postprandial glycemic responses (GRs) of a following rice meal, comparing with its co-ingestion counterpart and an apple sugar solution preload, based on equal carbohydrates intake. In a randomized crossover trial, 18 healthy female subjects consumed (1) rice, (2) co-ingestion of apple and rice (A+R), (3) apple preload and rice (PA+R), and (4) rice with sugar solution preload (same sugar profile as in apple) (PSS+R). Acute postprandial GR tests and subjective satiety tests were carried out for each test food. Compared with rice reference, the PA+R achieved a 50% reduction of the iAUC0-120, a 51.4% reduction of the average peak value, and a 52.6% reduction of glycemic excursion in 240 min, while the PSS+R showed 29.7% and 31.6% reduction of peak value and glycemic excursion, respectively. No significant differences were found between R and PA+R in any of the satiety characteristics. Compared with rice control, apple preload of 15 g available carbohydrates remarkably lowered the acute postprandial GR without negative effect on satiety. The sugar component may partly contribute to the glycemic suppressing effect of the apple preload.
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14
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Tosatti JAG, Bocardi VB, Jansen AK, Bernandes H, Silva FM. Determination of glycemic index of enteral formulas used in clinical practice. Int J Food Sci Nutr 2019; 71:201-210. [PMID: 31244367 DOI: 10.1080/09637486.2019.1634011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Glycemic Index (GI) is a measure of carbohydrate quality and is recognised as a valid and reproducible method of classifying carbohydrate foods according to its effects on postprandial glycaemia. In this randomised crossover trial (RBR-7rjx3k) we determined the GI of nine enteral formulas, following the Food and Agriculture Organisation/World Health Organisation method. Forty healthy participants were included in the study (85% female mean age 27.1 ± 6.7 years). GI of the enteral formulas ranged from 40.5 to 85.2; four formulas had high GI (Nutrienteral 1.5®, Novasource GI Control®, Diamax®, Isosource Soya®), two intermediate GI (Fresubin 1.2 HP Fibre®, Nutrison Energy Multifiber 1.5®) and three low GI (Trophic 1.5®, Glucerna®, Novasource GC HP®). The GI coefficient of variation ranged from 22.9% to 83.6%. The effect of the enteral formulas with low GI in glycemic control of patients with enteral nutrition prescription needs to be test in future studies.
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Affiliation(s)
| | | | - Ann Kristine Jansen
- Nutrition Department, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil
| | - Hugo Bernandes
- Risoleta Tolentino Neves Hospital, Belo Horizonte, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Postgraduation Program of Nutrition Science of Federal University of Healthy Science of Porto Alegre - UFCSPA, Porto Alegre, Brazil
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15
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Acute metabolic responses to high fructose corn syrup ingestion in adolescents with overweight/obesity and diabetes. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2019; 14:1-7. [PMID: 31058204 PMCID: PMC6497393 DOI: 10.1016/j.jnim.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: Childhood obesity remains high in prevalence. Sugar-sweetened beverages containing high fructose corn syrup (HFCS) are a common source of excess calories among children and adolescents. Fructose metabolism differs from glucose metabolism, which may also differ from fructose + glucose metabolism in HFCS consumption. The purpose of this study was to determine the acute metabolic effects of HFCS ingestion after soft drink consumption in adolescents who are lean, have overweight/obesity, or have type 2 diabetes (T2DM). Methods: Adolescents age 13–19 years were recruited into three groups: lean controls (n = 10), overweight/ obese without diabetes (n = 10), or uncomplicated T2DM on metformin monotherapy (n = 5). After an overnight fast, subjects drank 12 ounces of soda containing HFCS. Blood samples were collected at time zero and every 15 min for 120 min to be analyzed for fructose, glucose, and insulin levels. Results: Glucose and fructose concentrations rose quickly in the first 15 min. Fructose, which was very low at baseline, rose to 100–200 μM and remained higher than fasting concentrations even at 120 min in all groups. Glucose increased after soft drink consumption, with the highest concentrations among subjects with T2DM, but returned to baseline fasting levels at 120 min. Insulin levels increased 15 min after soft drink consumption and were the highest in the obese group. Lactate rose non-significantly in all subjects, with no differences between groups. Conclusion: Among adolescents who are lean, overweight/obese, or have T2DM, drinking an HFCS-containing soft drink exposes the liver to fructose. Glucose excursions in T2DM may be impacted by exaggerated glucose cycling, or fructose metabolism to glucose. The context of fructose consumption with or without other carbohydrates is an important consideration in studies of fructose metabolism.
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16
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Lum T, Connolly M, Marx A, Beidler J, Hooshmand S, Kern M, Liu C, Hong MY. Effects of Fresh Watermelon Consumption on the Acute Satiety Response and Cardiometabolic Risk Factors in Overweight and Obese Adults. Nutrients 2019; 11:E595. [PMID: 30870970 PMCID: PMC6470521 DOI: 10.3390/nu11030595] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 12/11/2022] Open
Abstract
Although some studies have demonstrated the beneficial effects of watermelon supplementation on metabolic diseases, no study has explored the potential mechanism by which watermelon consumption improves body weight management. The objective of this study was to evaluate the effects of fresh watermelon consumption on satiety, postprandial glucose and insulin response, and adiposity and body weight change after 4 weeks of intervention in overweight and obese adults. In a crossover design, 33 overweight or obese subjects consumed watermelon (2 cups) or isocaloric low-fat cookies daily for 4 weeks. Relative to cookies, watermelon elicited more (p < 0.05) robust satiety responses (lower hunger, prospective food consumption and desire to eat and greater fullness). Watermelon consumption significantly decreased body weight, body mass index (BMI), systolic blood pressure and waist-to-hip ratio (p ≤ 0.05). Cookie consumption significantly increased blood pressure and body fat (p < 0.05). Oxidative stress was lower at four week of watermelon intervention compared to cookie intervention (p = 0.034). Total antioxidant capacity increased with watermelon consumption (p = 0.003) in blood. This study shows that reductions in body weight, body mass index (BMI), and blood pressure can be achieved through daily consumption of watermelon, which also improves some factors associated with overweight and obesity (clinicaltrials.gov, NCT03380221).
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Affiliation(s)
- Tiffany Lum
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA.
| | - Megan Connolly
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA.
| | - Amanda Marx
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA.
| | - Joshua Beidler
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA.
| | - Shirin Hooshmand
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA.
| | - Mark Kern
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA.
| | - Changqi Liu
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA.
| | - Mee Young Hong
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA.
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Effect of dried fruit on postprandial glycemia: a randomized acute-feeding trial. Nutr Diabetes 2018; 8:59. [PMID: 30531821 PMCID: PMC6288147 DOI: 10.1038/s41387-018-0066-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/28/2018] [Accepted: 10/13/2018] [Indexed: 12/26/2022] Open
Abstract
Background/Objectives To investigate the effect of dried fruit in modifying postprandial glycemia, we assessed the ability of 4 dried fruits (dates, apricots, raisins, sultanas) to decrease postprandial glycemia through three mechanisms: a glycemic index (GI) effect, displacement effect, or ‘catalytic’ fructose effect. Subjects/Methods We conducted an acute randomized, multiple-crossover trial in an outpatient setting in 10 healthy adults. Participants received 3 white bread control meals and 12 dried fruit test meals in random order. The test meals included each of 4 dried fruits (dates, apricots, raisins, sultanas) alone (GI effect), 4 of the dried fruits displacing half the available carbohydrate in white bread (displacement effect), or 4 of the dried fruits providing a small ‘catalytic’ dose (7.5 g) of fructose added to white bread (‘catalytic’ fructose effect). The protocol followed the ISO method for the determination of GI (ISO 26642:2010). The primary outcome was mean ± SEM GI (glucose scale) for ease of comparison across the three mechanisms. Results Ten healthy participants (7 men, 3 women; mean ± SD age and BMI: 39 ± 12 years and 25 ± 2 kg/m2) were recruited and completed the trial. All dried fruit had a GI below that of white bread (GI = 71); however, only dried apricots (GI = 42 ± 5), raisins (GI = 55 ± 5), and sultanas (51 ± 4) showed a significant GI effect (P < 0.05). When displacing half the available carbohydrate in white bread, all dried fruit lowered the GI; however, only dried apricots (GI = 57 ± 5) showed a significant displacement effect (P = 0.025). None of the dried fruits showed a beneficial ‘catalytic’ fructose effect. Conclusions In conclusion, dried fruits have a lower GI and reduce the glycemic response of white bread through displacement of half of the available carbohydrate. Longer-term randomized trials are needed to confirm whether dried fruit can contribute to sustainable improvements in glycemic control. Trial registration ClinicalTrials.gov identifier, NCT02960373
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18
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The Effect of Small Doses of Fructose and Its Epimers on Glycemic Control: A Systematic Review and Meta-Analysis of Controlled Feeding Trials. Nutrients 2018; 10:nu10111805. [PMID: 30463314 PMCID: PMC6266436 DOI: 10.3390/nu10111805] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 01/08/2023] Open
Abstract
Objective: Contrary to the concerns that fructose may have adverse metabolic effects, an emerging literature has shown that small doses (≤10 g/meal) of fructose and its low-caloric epimers (allulose, tagatose, and sorbose) decrease the glycemic response to high glycemic index meals. Whether these acute reductions manifest as sustainable improvements in glycemic control is unclear. Our objective was to synthesize the evidence from controlled feeding trials that assessed the effect of small doses of fructose and its low-caloric epimers on glycemic control. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library through April 18, 2018. We included controlled feeding trials of ≥1 week that investigated the effect of small doses (≤50 g/day or ≤10% of total energy intake/day) of fructose and its low-caloric epimers on HbA1c, fasting glucose, and fasting insulin. Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the generic inverse variance method and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the Cochran Q statistic and quantified using the I² statistic. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessed the certainty of the evidence. Results: We identified 14 trial comparisons (N = 337) of the effect of fructose in individuals with and without diabetes, 3 trial comparisons (N = 138) of the effect of allulose in individuals without diabetes, 3 trial comparisons (N = 376) of the effect of tagatose mainly in individuals with type 2 diabetes, and 0 trial comparisons of the effect of sorbose. Small doses of fructose and tagatose significantly reduced HbA1c (MD = -0.38% (95% CI: -0.64%, -0.13%); MD = -0.20% (95% CI: -0.34%, -0.06%)) and fasting glucose (MD = -0.13 mmol/L (95% CI: -0.24 mmol/L, -0.03 mmol/L)); MD = -0.30 mmol/L (95% CI: -0.57 mmol/L, -0.04 mmol/L)) without affecting fasting insulin (p > 0.05). Small doses of allulose did not have a significant effect on HbA1c and fasting insulin (p > 0.05), while the reduction in fasting glucose was of borderline significance (p = 0.05). The certainty of the evidence of the effect of small doses of fructose and allulose on HbA1c, fasting glucose, and fasting insulin was graded as low. The certainty of the evidence of the effect of tagatose on HbA1c, fasting glucose, and fasting insulin was graded as moderate. Conclusions: Our results indicate that small doses of fructose and tagatose may improve glycemic control over the long term. There is a need for long-term randomized controlled trials for all four sugars to improve our certainty in the estimates.
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Camps SG, Koh HR, Wang NX, Henry CJ. High fructose consumption with a high-protein meal is associated with decreased glycemia and increased thermogenesis but reduced fat oxidation: A randomized controlled trial. Nutrition 2018; 58:77-82. [PMID: 30391694 DOI: 10.1016/j.nut.2018.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/04/2018] [Accepted: 06/09/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Fructose is often recommended due to its ability to lower glycemic response and its increased thermogenic effect. Additionally, proteins can reduce the glycemic response of carbohydrate-rich foods and have a high diet-induced thermogenesis (DIT). The aim of this study was to investigate whether the inclusion of fructose in a high-protein meal would demonstrate metabolic advantages. METHODS Nineteen Asian women (body mass index 17-28 kg/m2) consumed a low-glycemic index (GI; fructose) or high GI (glucose), high-protein breakfast followed by a standardized lunch in a randomized crossover design. Simultaneously, 8-h continuous glucose monitoring provided incremental area under the curve (iAUC) and 4-h indirect calorimetry provided DIT and respiratory quotient (RQ). RESULTS The low GI diet resulted in a lower glucose iAUC (135 ± 25 versus 212 ± 23 mmol/L, P < 0.05) following breakfast, but no second-meal effect after the standardized lunch (217 ± 37 versus 228 ± 27 mmol/L, P < 0.05) compared with the high GI diet. Furthermore, 4-h DIT was greater (40.6 ± 2.3 versus 34.9 ± 1.8 kcal, P < 0.05) and RQ was increased after the fructose high-protein breakfast (0.047 ± 0.009 versus 0.028 ± 0.009, P < 0.05) compared with the glucose meal. CONCLUSIONS Fructose is an effective sweetener in reducing glycemia and increasing DIT in the presence of a high-protein diet. However, the reduced fat oxidation after high fructose consumption might present a risk for increased lipogenesis.
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Affiliation(s)
- Stefan Gerardus Camps
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research and National University Health System Centre for Translational Medicine, Yong Loo Lin School of Medicine, Singapore
| | - Huann Rong Koh
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research and National University Health System Centre for Translational Medicine, Yong Loo Lin School of Medicine, Singapore
| | - Nan Xin Wang
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research and National University Health System Centre for Translational Medicine, Yong Loo Lin School of Medicine, Singapore
| | - Christiani Jeyakumar Henry
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research and National University Health System Centre for Translational Medicine, Yong Loo Lin School of Medicine, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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20
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Noronha JC, Braunstein CR, Glenn AJ, Khan TA, Viguiliouk E, Noseworthy R, Blanco Mejia S, Kendall CWC, Wolever TMS, Leiter LA, Sievenpiper JL. The effect of small doses of fructose and allulose on postprandial glucose metabolism in type 2 diabetes: A double-blind, randomized, controlled, acute feeding, equivalence trial. Diabetes Obes Metab 2018; 20:2361-2370. [PMID: 29797503 PMCID: PMC6175314 DOI: 10.1111/dom.13374] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 01/19/2023]
Abstract
AIM To assess and compare the effect of small doses of fructose and allulose on postprandial blood glucose regulation in type 2 diabetes. METHODS A double-blind, multiple-crossover, randomized, controlled, acute feeding, equivalence trial in 24 participants with type 2 diabetes was conducted. Each participant was randomly assigned six treatments separated by >1-week washouts. Treatments consisted of fructose or allulose at 0 g (control), 5 g or 10 g added to a 75-g glucose solution. A standard 75-g oral glucose tolerance test protocol was followed with blood samples at -30, 0, 30, 60, 90 and 120 minutes. The primary outcome measure was plasma glucose incremental area under the curve (iAUC). RESULTS Allulose significantly reduced plasma glucose iAUC by 8% at 10 g compared with 0 g (717.4 ± 38.3 vs. 777.5 ± 39.9 mmol × min/L, P = 0.015) with a linear dose response gradient between the reduction in plasma glucose iAUC and dose (P = 0.016). Allulose also significantly reduced several related secondary and exploratory outcome measures at 5 g (plasma glucose absolute mean and total AUC) and 10 g (plasma glucose absolute mean, absolute and incremental maximum concentration [Cmax ], and total AUC) (P < .0125). There was no effect of fructose at any dose. Although allulose showed statistically significant reductions in plasma glucose iAUC compared with fructose at 5 g, 10 g and pooled doses, these reductions were within the pre-specified equivalence margins of ±20%. CONCLUSION Allulose, but not fructose, led to modest reductions in the postprandial blood glucose response to oral glucose in individuals with type 2 diabetes. There is a need for long-term randomized trials to confirm the sustainability of these improvements.
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Affiliation(s)
- Jarvis C. Noronha
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Catherine R. Braunstein
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Andrea J. Glenn
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Tauseef A. Khan
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Effie Viguiliouk
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Rebecca Noseworthy
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Sonia Blanco Mejia
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Cyril W. C. Kendall
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- College of Pharmacy and NutritionUniversity of SaskatchewanSaskatoonCanada
| | - Thomas M. S. Wolever
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
| | - Lawrence A. Leiter
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
| | - John L. Sievenpiper
- Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification CentreSt. Michael's HospitalTorontoCanada
- Department of Nutritional Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
- Division of EndocrinologySt. Michael's HospitalTorontoCanada
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21
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A Double-Blind, Randomized Controlled, Acute Feeding Equivalence Trial of Small, Catalytic Doses of Fructose and Allulose on Postprandial Blood Glucose Metabolism in Healthy Participants: The Fructose and Allulose Catalytic Effects (FACE) Trial. Nutrients 2018; 10:nu10060750. [PMID: 29890724 PMCID: PMC6024645 DOI: 10.3390/nu10060750] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 01/24/2023] Open
Abstract
Recent literature suggests that catalytic doses (≤10 g/meal or 36 g/day) of D-fructose and D-allulose may reduce postprandial blood glucose responses to carbohydrate loads in people with and without type 2 diabetes by inducing glycogen synthesis. To assess the effect of small single doses of fructose and allulose on postprandial blood glucose regulation in response to a 75 g-oral glucose tolerance test (75 g-OGTT) in healthy individuals, we conducted an acute randomized, crossover, equivalence trial in healthy adults. Each participant randomly received six treatments, separated by a minimum one-week washout. Treatments consisted of a 75 g-OGTT with the addition of fructose or allulose at 0 g (control), 5 g or 10 g. A standard 75 g-OGTT protocol was followed with blood samples at −30, 0, 30, 60, 90, 120 min. The primary outcome was the difference in plasma glucose incremental area under the curve (iAUC). A total of 27 participants underwent randomization with data available from 25 participants. Small doses of fructose or allulose did not show a significant effect on plasma glucose iAUC or other secondary markers of postprandial blood glucose regulation in response to a 75 g-OGTT in healthy individuals. These results were limited by the low power to detect a significant difference, owing to greater than expected intra-individual coefficient of variation (CV) in plasma glucose iAUC. Overall, we failed to confirm the catalytic effects of small doses of fructose and allulose in healthy individuals. Future trials may consider recruiting larger sample sizes of healthy individuals. Trial registration: clinicaltrials.gov identifier, NCT02459834.
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Evans RA, Frese M, Romero J, Cunningham JH, Mills KE. Fructose replacement of glucose or sucrose in food or beverages lowers postprandial glucose and insulin without raising triglycerides: a systematic review and meta-analysis. Am J Clin Nutr 2017; 106:506-518. [PMID: 28592611 DOI: 10.3945/ajcn.116.145151] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 05/01/2017] [Indexed: 11/14/2022] Open
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.
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Affiliation(s)
| | - Michael Frese
- Health Research Institute.,Faculty of Education, Science, Technology and Mathematics, and
| | - Julio Romero
- Department of Software Engineering and Artificial Intelligence, University of Canberra, Canberra, Australia; and
| | - Judy H Cunningham
- Formerly of Risk Assessment Chemical Safety and Nutrition, Food Standards Australia New Zealand, Canberra, Australia
| | - Kerry E Mills
- Health Research Institute, .,Faculty of Education, Science, Technology and Mathematics, and
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23
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Sievenpiper JL. Sickeningly Sweet: Does Sugar Cause Chronic Disease? No. Can J Diabetes 2017; 40:287-95. [PMID: 27497149 DOI: 10.1016/j.jcjd.2016.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 12/29/2022]
Affiliation(s)
- John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
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24
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Rippe JM, Sievenpiper JL, Lê KA, White JS, Clemens R, Angelopoulos TJ. What is the appropriate upper limit for added sugars consumption? Nutr Rev 2017; 75:18-36. [PMID: 27974597 PMCID: PMC5916235 DOI: 10.1093/nutrit/nuw046] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Dramatic increases in obesity and diabetes have occurred worldwide over the past 30 years. Some investigators have suggested that these increases may be due, in part, to increased added sugars consumption. Several scientific organizations, including the World Health Organization, the Scientific Advisory Council on Nutrition, the Dietary Guidelines Advisory Committee 2015, and the American Heart Association, have recommended significant restrictions on upper limits of sugars consumption. In this review, the scientific evidence related to sugars consumption and its putative link to various chronic conditions such as obesity, diabetes, heart disease, nonalcoholic fatty liver disease, and the metabolic syndrome is examined. While it appears prudent to avoid excessive calories from sugars, the scientific basis for restrictive guidelines is far from settled.
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Affiliation(s)
- James M Rippe
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA.
| | - John L Sievenpiper
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
| | - Kim-Anne Lê
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
| | - John S White
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
| | - Roger Clemens
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
| | - Theodore J Angelopoulos
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
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Vasankari TJ, Vasankari TM. Effect of dietary fructose on lipid metabolism, body weight and glucose tolerance in humans. SCANDINAVIAN JOURNAL OF FOOD & NUTRITION 2016. [DOI: 10.1080/17482970600783356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tommi J Vasankari
- Department of Health and ExerciseUniversity of Turku and Paavo Nurmi Center, Sports Medical Research UnitTurkuFinland
- Department of Exercise MedicineSport Institute of FinlandVierumakiFinland
| | - Tuula M Vasankari
- Department of Respiratory MedicineTurku University HospitalTurkuFinland
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26
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Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding. Nutrients 2016; 8:nu8110697. [PMID: 27827899 PMCID: PMC5133084 DOI: 10.3390/nu8110697] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/11/2016] [Accepted: 10/25/2016] [Indexed: 02/07/2023] Open
Abstract
Added sugars are a controversial and hotly debated topic. Consumption of added sugars has been implicated in increased risk of a variety of chronic diseases including obesity, cardiovascular disease, diabetes and non-alcoholic fatty liver disease (NAFLD) as well as cognitive decline and even some cancers. Support for these putative associations has been challenged, however, on a variety of fronts. The purpose of the current review is to summarize high impact evidence including systematic reviews, meta-analyses, and randomized controlled trials (RCTs), in an attempt to provide an overview of current evidence related to added sugars and health considerations. This paper is an extension of a symposium held at the Experimental Biology 2015 conference entitled “Sweeteners and Health: Current Understandings, Controversies, Recent Research Findings and Directions for Future Research”. We conclude based on high quality evidence from randomized controlled trials (RCT), systematic reviews and meta-analyses of cohort studies that singling out added sugars as unique culprits for metabolically based diseases such as obesity, diabetes and cardiovascular disease appears inconsistent with modern, high quality evidence and is very unlikely to yield health benefits. While it is prudent to consume added sugars in moderation, the reduction of these components of the diet without other reductions of caloric sources seems unlikely to achieve any meaningful benefit.
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27
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Khan TA, Sievenpiper JL. Controversies about sugars: results from systematic reviews and meta-analyses on obesity, cardiometabolic disease and diabetes. Eur J Nutr 2016; 55:25-43. [PMID: 27900447 PMCID: PMC5174149 DOI: 10.1007/s00394-016-1345-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023]
Abstract
Fructose-containing sugars are a focus of attention as a public health target for their putative role in obesity and cardiometabolic disease including diabetes. The fructose moiety is singled out to be the primary driver for the harms of sugars due to its unique endocrine signal and pathophysiological role. However, this is only supported by ecological studies, animal models of overfeeding and select human intervention studies with supraphysiological doses or lack of control for energy. The highest level of evidence from systematic reviews and meta-analyses of controlled trials has not shown that fructose-containing sugars behave any differently from other forms of digestible carbohydrates. Fructose-containing sugars can only lead to weight gain and other unintended harms on cardiometabolic risk factors insofar as the excess calories they provide. Prospective cohort studies, which provide the strongest observational evidence, have shown an association between fructose-containing sugars and cardiometabolic risk including weight gain, cardiovascular disease outcomes and diabetes only when restricted to sugar-sweetened beverages and not for sugars from other sources. In fact, sugar-sweetened beverages are a marker of an unhealthy lifestyle and their drinkers consume more calories, exercise less, smoke more and have a poor dietary pattern. The potential for overconsumption of sugars in the form of sugary foods and drinks makes targeting sugars, as a source of excess calories, a prudent strategy. However, sugar content should not be the sole determinant of a healthy diet. There are many other factors in the diet-some providing excess calories while others provide beneficial nutrients. Rather than just focusing on one energy source, we should consider the whole diet for health benefits.
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Affiliation(s)
- Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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28
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Evans RA, Lithander FE, Frese M, Cunningham JH, Mills KE, Romero J. Fructose substitution of glucose or sucrose in food for normoglycaemic persons or people with or at risk of diabetes. Hippokratia 2016. [DOI: 10.1002/14651858.cd011840.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rebecca A Evans
- University of Canberra; Health Research Centre; University Drive Bruce ACT Australia 2617
| | - Fiona E Lithander
- University of Canberra; Department of Nutrition and Dietetics; Bruce Canberra ACT Australia 2617
| | - Michael Frese
- University of Canberra; Faculty of Education, Science, Technology and Mathematics; Bruce ACT Australia 2617
| | - Judy H Cunningham
- Food Standards Australia New Zealand; Formerly of Risk Assessment Chemical Safety and Nutrition; 6/42 Caroline Street Annerley Queensland Australia 4103
| | - Kerry E Mills
- Systematic Solutions; 31 Dwyer St Cook ACT Australia 2614
| | - Julio Romero
- University of Canberrra; Department of Software Engineering and Artificial Intelligence; Bruce Canberra ACT Australia 2617
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Augustin LSA, Kendall CWC, Jenkins DJA, Willett WC, Astrup A, Barclay AW, Björck I, Brand-Miller JC, Brighenti F, Buyken AE, Ceriello A, La Vecchia C, Livesey G, Liu S, Riccardi G, Rizkalla SW, Sievenpiper JL, Trichopoulou A, Wolever TMS, Baer-Sinnott S, Poli A. Glycemic index, glycemic load and glycemic response: An International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC). Nutr Metab Cardiovasc Dis 2015; 25:795-815. [PMID: 26160327 DOI: 10.1016/j.numecd.2015.05.005] [Citation(s) in RCA: 377] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS The positive and negative health effects of dietary carbohydrates are of interest to both researchers and consumers. METHODS International experts on carbohydrate research held a scientific summit in Stresa, Italy, in June 2013 to discuss controversies surrounding the utility of the glycemic index (GI), glycemic load (GL) and glycemic response (GR). RESULTS The outcome was a scientific consensus statement which recognized the importance of postprandial glycemia in overall health, and the GI as a valid and reproducible method of classifying carbohydrate foods for this purpose. There was consensus that diets low in GI and GL were relevant to the prevention and management of diabetes and coronary heart disease, and probably obesity. Moderate to weak associations were observed for selected cancers. The group affirmed that diets low in GI and GL should always be considered in the context of diets otherwise understood as healthy, complementing additional ways of characterizing carbohydrate foods, such as fiber and whole grain content. Diets of low GI and GL were considered particularly important in individuals with insulin resistance. CONCLUSIONS Given the high prevalence of diabetes and pre-diabetes worldwide and the consistency of the scientific evidence reviewed, the expert panel confirmed an urgent need to communicate information on GI and GL to the general public and health professionals, through channels such as national dietary guidelines, food composition tables and food labels.
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Affiliation(s)
- L S A Augustin
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.
| | - C W C Kendall
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada; University of Saskatchewan, Saskatoon, Canada
| | - D J A Jenkins
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada
| | - W C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, USA
| | - A Astrup
- Department of Nutrition, Exercise and Sports (NEXS), Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - A W Barclay
- Glycemic Index Foundation, Sydney, Australia
| | - I Björck
- Food for Health Science Centre, Lund University, Lund, Sweden
| | - J C Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia
| | - F Brighenti
- Department of Food Sciences, University of Parma, Parma, Italy
| | - A E Buyken
- Department of Nutritional Epidemiology, University of Bonn, Bonn, Germany
| | - A Ceriello
- Institut d' Investigación Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Spain
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - G Livesey
- Independent Nutrition Logic, Wymondham, UK
| | - S Liu
- Department of Epidemiology and Medicine, Brown University, Providence, USA
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - S W Rizkalla
- Institute Cardiometabolism and Nutrition (ICAN), University Pierre et Marie Curie, Pitié Salpêtrière Hospital, Paris, France; National Institute of Health and Medical Research (INSERM), University Pierre et Marie Curie and Pitié Salpêtrière Hospital, Paris, France
| | - J L Sievenpiper
- Department of Nutritional Science, University of Toronto, Toronto, Canada
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - T M S Wolever
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada; Department of Nutritional Science, University of Toronto, Toronto, Canada
| | | | - A Poli
- Nutrition Foundation of Italy, Milan, Italy
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Kelishadi R, Mansourian M, Heidari-Beni M. Association of fructose consumption and components of metabolic syndrome in human studies: a systematic review and meta-analysis. Nutrition 2014; 30:503-10. [PMID: 24698343 DOI: 10.1016/j.nut.2013.08.014] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/23/2013] [Accepted: 08/17/2013] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Roya Kelishadi
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Motahar Heidari-Beni
- Food Security Research Center and Department of Community Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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Hale C, Lloyd DJ, Pellacani A, Véniant MM. Molecular targeting of the GK-GKRP pathway in diabetes. Expert Opin Ther Targets 2014; 19:129-39. [DOI: 10.1517/14728222.2014.965681] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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33
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Normal roles for dietary fructose in carbohydrate metabolism. Nutrients 2014; 6:3117-29. [PMID: 25100436 PMCID: PMC4145298 DOI: 10.3390/nu6083117] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/16/2014] [Accepted: 07/24/2014] [Indexed: 01/22/2023] Open
Abstract
Although there are many well-documented metabolic effects linked to the fructose component of a very high sugar diet, a healthy diet is also likely to contain appreciable fructose, even if confined to that found in fruits and vegetables. These normal levels of fructose are metabolized in specialized pathways that synergize with glucose at several metabolic steps. Glucose potentiates fructose absorption from the gut, while fructose catalyzes glucose uptake and storage in the liver. Fructose accelerates carbohydrate oxidation after a meal. In addition, emerging evidence suggests that fructose may also play a role in the secretion of insulin and GLP-1, and in the maturation of preadipocytes to increase fat storage capacity. Therefore, fructose undergoing its normal metabolism has the interesting property of potentiating the disposal of a dietary carbohydrate load through several routes.
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Exercise and dietary-mediated reductions in postprandial lipemia. J Nutr Metab 2014; 2014:902065. [PMID: 25061524 PMCID: PMC4100364 DOI: 10.1155/2014/902065] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/03/2014] [Accepted: 06/09/2014] [Indexed: 01/15/2023] Open
Abstract
Postprandial hyperlipemia produces long-term derangements in lipid/lipoprotein metabolism, vascular endothelial dysfunction, hypercoagulability, and sympathetic hyperactivity which are strongly linked to atherogenesis. The purpose of this review is to (1) provide a qualitative analysis of the available literature examining the dysregulation of postprandial lipid metabolism in the presence of obesity, (2) inspect the role of adiposity distribution and sex on postprandial lipid metabolism, and (3) examine the role of energy deficit (exercise- and/or energy restriction-mediated), isoenergetic low-carbohydrate diets, and omega-3 (n-3) fatty acid supplementation on postprandial lipid metabolism. We conclude from the literature that central adiposity primarily accounts for sex-related differences in postprandial lipemia and that aerobic exercise attenuates this response in obese or lean men and women to a similar extent through potentially unique mechanisms. In contrast, energy restriction produces only mild reductions in postprandial lipemia suggesting that exercise may be superior to energy restriction alone as a strategy for lowering postprandial lipemia. However, isoenergetic very low-carbohydrate diets and n-3 fatty acid supplementation reduce postprandial lipemia indicating that macronutrient manipulations reduce postprandial lipemia in the absence of energy restriction. Therefore, interactions between exercise/energy restriction and alterations in macronutrient content remain top priorities for the field to identify optimal behavioral treatments to reduce postprandial lipemia.
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Abstract
The glucokinase (GK) enzyme (EC 2.7.1.1.) is essential for the use of dietary glucose because it is the first enzyme to phosphorylate glucose in excess in different key tissues such as the pancreas and liver. The objective of the present review is not to fully describe the biochemical characteristics and the genetics of this enzyme but to detail its nutritional regulation in different vertebrates from fish to human. Indeed, the present review will describe the existence of the GK enzyme in different animal species that have naturally different levels of carbohydrate in their diets. Thus, some studies have been performed to analyse the nutritional regulation of the GK enzyme in humans and rodents (having high levels of dietary carbohydrates in their diets), in the chicken (moderate level of carbohydrates in its diet) and rainbow trout (no carbohydrate intake in its diet). All these data illustrate the nutritional importance of the GK enzyme irrespective of feeding habits, even in animals known to poorly use dietary carbohydrates (carnivorous species).
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Ueta K, O'Brien TP, McCoy GA, Kim K, Healey EC, Farmer TD, Donahue EP, Condren AB, Printz RL, Shiota M. Glucotoxicity targets hepatic glucokinase in Zucker diabetic fatty rats, a model of type 2 diabetes associated with obesity. Am J Physiol Endocrinol Metab 2014; 306:E1225-38. [PMID: 24714398 PMCID: PMC4042096 DOI: 10.1152/ajpendo.00507.2013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A loss of glucose effectiveness to suppress hepatic glucose production as well as increase hepatic glucose uptake and storage as glycogen is associated with a defective increase in glucose phosphorylation catalyzed by glucokinase (GK) in Zucker diabetic fatty (ZDF) rats. We extended these observations by investigating the role of persistent hyperglycemia (glucotoxicity) in the development of impaired hepatic GK activity in ZDF rats. We measured expression and localization of GK and GK regulatory protein (GKRP), translocation of GK, and hepatic glucose flux in response to a gastric mixed meal load (MMT) and hyperglycemic hyperinsulinemic clamp after 1 or 6 wk of treatment with the sodium-glucose transporter 2 inhibitor (canaglifrozin) that was used to correct the persistent hyperglycemia of ZDF rats. Defective augmentation of glucose phosphorylation in response to a rise in plasma glucose in ZDF rats was associated with the coresidency of GKRP with GK in the cytoplasm in the midstage of diabetes, which was followed by a decrease in GK protein levels due to impaired posttranscriptional processing in the late stage of diabetes. Correcting hyperglycemia from the middle diabetic stage normalized the rate of glucose phosphorylation by maintaining GK protein levels, restoring normal nuclear residency of GK and GKRP under basal conditions and normalizing translocation of GK from the nucleus to the cytoplasm, with GKRP remaining in the nucleus in response to a rise in plasma glucose. This improved the liver's metabolic ability to respond to hyperglycemic hyperinsulinemia. Glucotoxicity is responsible for loss of glucose effectiveness and is associated with altered GK regulation in the ZDF rat.
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Affiliation(s)
- Kiichiro Ueta
- Department of Molecular Physiology and Biophysics and
| | | | | | - Kuikwon Kim
- Department of Molecular Physiology and Biophysics and
| | - Erin C Healey
- Department of Molecular Physiology and Biophysics and
| | - Tiffany D Farmer
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - E Patrick Donahue
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Richard L Printz
- Department of Molecular Physiology and Biophysics and Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Masakazu Shiota
- Department of Molecular Physiology and Biophysics and Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, Tennessee
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Study on the Postprandial Blood Glucose Suppression Effect ofD-Psicose in Borderline Diabetes and the Safety of Long-Term Ingestion by Normal Human Subjects. Biosci Biotechnol Biochem 2014; 74:510-9. [DOI: 10.1271/bbb.90707] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kahn R, Sievenpiper JL. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: we have, but the pox on sugar is overwrought and overworked. Diabetes Care 2014; 37:957-62. [PMID: 24652726 DOI: 10.2337/dc13-2506] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In the preceding point narrative, Drs. Bray and Popkin provide their opinion and review data that suggest to them that we need to reconsider the consumption of dietary sugar based on the growing concern of obesity and type 2 diabetes. In the counterpoint narrative below, we argue that there is no clear or convincing evidence that any dietary or added sugar has a unique or detrimental impact relative to any other source of calories on the development of obesity or diabetes. Sugar is purely a highly palatable source of energy; because it has no other property that appears to contribute to our nutritional well-being, it is not an essential food for most of us. For those who wish to reduce energy consumption, ingesting less sugar is a good place to start. However, doing so does not automatically portend any clinical benefit.
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Kearney FM, Fagan XJ, Al-Qureshi S. Review of the role of refined dietary sugars (fructose and glucose) in the genesis of retinal disease. Clin Exp Ophthalmol 2014; 42:564-73. [PMID: 24373051 DOI: 10.1111/ceo.12290] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/16/2013] [Indexed: 01/08/2023]
Abstract
This review examines the current evidence of the relationship between sugar consumption and the development of retinal and other eye diseases including diabetic retinopathy, hypertensive retinopathy, age-related macular degeneration, non-arteritic anterior ischaemic optic neuropathy and cataract. Sucrose is comprised of fructose and glucose. Sugar consumption has increased five-fold over the last century, with high quantities of sucrose and high-fructose corn syrup found in processed food and soft drinks. This increased consumption is increasingly recognized as a central factor in the rapidly rising rates of obesity and type 2 diabetes. The body metabolizes fructose and glucose differently, with fructose appearing to have the greater propensity to contribute to the metabolic syndrome. This review examines the effect of high rates of dietary consumption of refined carbohydrates on the eye, including the effect of chronic hyperglycaemia on microvascular disease in diabetic retinopathy, and the pathophysiological changes in the retinal circulation in hypertensive retinopathy.
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Affiliation(s)
- Frances M Kearney
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria; Vision Centre Gold Coast, Southport, Queensland, Australia
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Cozma AI, Sievenpiper JL. The Role of Fructose, Sucrose and High-fructose Corn Syrup in Diabetes. EUROPEAN ENDOCRINOLOGY 2014; 10:51-60. [PMID: 29872464 DOI: 10.17925/ee.2014.10.01.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/28/2013] [Indexed: 11/24/2022]
Abstract
Concerns are growing regarding the role of dietary sugars in the development of obesity and cardiometabolic diseases, including diabetes. High-fructose corn syrup (HFCS) and sucrose are the most important dietary sweeteners. Both HFCS and sucrose have overlapping metabolic actions with adverse effects attributed to their fructose moiety. Ecological studies have linked the rise in fructose availability with the increases in obesity and diabetes worldwide. This link has been largely underpinned by animal models and select human trials of fructose overfeeding at high levels of exposure. Although prospective cohort studies have shown significant associations comparing the highest with the lowest levels of intake sugar-sweetened beverages, these associations are small, do not hold at moderate levels of intake and are subject to collinearity effects from related dietary and lifestyle factors. Most systematic reviews and meta-analyses from controlled feeding trials have shown that fructose-containing sugars in isocaloric exchange for other carbohydrates do not show evidence of harm and, in the case of fructose, may even have advantages for glycaemic control, especially at small doses. Nevertheless, trials in which fructose-containing sugars supplement diets with excess energy have shown adverse effects, effects that appear more attributable to the excess energy than the sugar. There is no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects, although there is potentially cause for concern where fructose is provided at high doses or contributes excess energy to diets. Further investigation is warranted due to the significant knowledge gaps and weaknesses in existing research.
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Affiliation(s)
- Adrian I Cozma
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada.,Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Abstract
What do the Atkins Diet and the traditional Japanese diet have in common? The Atkins Diet is low in carbohydrate and usually high in fat; the Japanese diet is high in carbohydrate and usually low in fat. Yet both work to promote weight loss. One commonality of both diets is that they both eliminate the monosaccharide fructose. Sucrose (table sugar) and its synthetic sister high fructose corn syrup consist of 2 molecules, glucose and fructose. Glucose is the molecule that when polymerized forms starch, which has a high glycemic index, generates an insulin response, and is not particularly sweet. Fructose is found in fruit, does not generate an insulin response, and is very sweet. Fructose consumption has increased worldwide, paralleling the obesity and chronic metabolic disease pandemic. Sugar (i.e., fructose-containing mixtures) has been vilified by nutritionists for ages as a source of "empty calories," no different from any other empty calorie. However, fructose is unlike glucose. In the hypercaloric glycogen-replete state, intermediary metabolites from fructose metabolism overwhelm hepatic mitochondrial capacity, which promotes de novo lipogenesis and leads to hepatic insulin resistance, which drives chronic metabolic disease. Fructose also promotes reactive oxygen species formation, which leads to cellular dysfunction and aging, and promotes changes in the brain's reward system, which drives excessive consumption. Thus, fructose can exert detrimental health effects beyond its calories and in ways that mimic those of ethanol, its metabolic cousin. Indeed, the only distinction is that because fructose is not metabolized in the central nervous system, it does not exert the acute neuronal depression experienced by those imbibing ethanol. These metabolic and hedonic analogies argue that fructose should be thought of as "alcohol without the buzz."
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Affiliation(s)
- Robert H Lustig
- Department of Pediatrics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
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Delgado TC, Martins FO, Carvalho F, Gonçalves A, Scott DK, O'Doherty R, Macedo MP, Jones JG. ²H enrichment distribution of hepatic glycogen from ²H₂O reveals the contribution of dietary fructose to glycogen synthesis. Am J Physiol Endocrinol Metab 2013; 304:E384-91. [PMID: 23211519 DOI: 10.1152/ajpendo.00185.2012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dietary fructose can benefit or hinder glycemic control, depending on the quantity consumed, and these contrasting effects are reflected by alterations in postprandial hepatic glycogen synthesis. Recently, we showed that ²H enrichment of glycogen positions 5 and 2 from deuterated water (²H₂O) informs direct and indirect pathway contributions to glycogenesis in naturally feeding rats. Inclusion of position 6(S) ²H enrichment data allows indirect pathway sources to be further resolved into triose phosphate and Krebs cycle precursors. This analysis was applied to six rats that had fed on standard chow (SC) and six rats that had fed on SC plus 35% sucrose in their drinking water (HS). After 2 wk, hepatic glycogenesis sources during overnight feeding were determined by ²H₂O administration and postmortem analysis of glycogen ²H enrichment at the conclusion of the dark period. Net overnight hepatic glycogenesis was similar between SC and HS rodents. Whereas direct pathway contributions were similar (403 ± 71 μmol/g dry wt HS vs. 578 ± 76 μmol/g dry wt SC), triose phosphate contributions were significantly higher for HS compared with SC (382 ± 61 vs. 87 ± 24 μmol/g dry wt, P < 0.01) and Krebs cycle inputs lower for HS compared with SC (110 ± 9 vs. 197 ± 32 μmol/g dry wt, P < 0.05). Analysis of plasma glucose ²H enrichments at the end of the feeding period also revealed a significantly higher fractional contribution of triose phosphate to plasma glucose levels in HS vs. SC. Hence, the ²H enrichment distributions of hepatic glycogen and glucose from ²H₂O inform the contribution of dietary fructose to hepatic glycogen and glucose synthesis.
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Affiliation(s)
- Teresa C Delgado
- Intermediary Metabolism Group, Center for Neurosciences and Cell Biology of Coimbra, Coimbra, Portugal
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Sjöstrand M, Ericsson H, Hartford M, Norjavaara E, Eriksson JW. Pharmacodynamic effects of the oral glucokinase activator AZD6370 after single doses in healthy volunteers assessed with euglycaemic clamp. Diabetes Obes Metab 2013; 15:35-41. [PMID: 22958202 DOI: 10.1111/j.1463-1326.2012.01672.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/03/2012] [Accepted: 07/31/2012] [Indexed: 11/28/2022]
Abstract
AIMS This study evaluated the safety, tolerability, pharmacokinetics and pharmacodynamic effects of the glucokinase activator (GKA) AZD6370 in non-diabetic subjects, using the euglycaemic clamp to avoid the risk of hypoglycaemia. METHODS Oral single ascending doses of AZD6370 10-650 mg or subcutaneous short-acting insulin 4 or 12 U were given to healthy fasting subjects. AZD6370 safety, tolerability and pharmacokinetics were assessed. Pharmacodynamic effects on serum (S)-insulin and glucose infusion rate (GIR) were investigated with euglycaemic clamp. AZD6370 10-20 mg was also assessed when taken with food without euglycaemic clamp. RESULTS AZD6370 was well tolerated and no safety concerns were raised. AZD6370 was rapidly absorbed and eliminated, and plasma concentration was proportional to dose. Both S-insulin and GIR increased following AZD6370 administration. The observed increase in GIR correlated with increasing AZD6370 area under the plasma concentration vs. time curve, demonstrating a dose-concentration-dependent pharmacodynamic effect. AZD6370 at doses of 50 and 80 mg had similar effects to short-acting insulin 4 U on peripheral S-insulin levels but greater effects on GIR, suggesting an effect beyond the increase of peripheral S-insulin levels at lower doses. In the food interaction part of the study, performed without euglycaemic clamp, dose escalation was stopped at a low dose (20 mg) because of hypoglycaemia. CONCLUSION The euglycaemic clamp was successfully used to avoid hypoglycaemia and to demonstrate pharmacodynamic effects, that is, markedly increased insulin secretion and glucose utilisation, following administration of AZD6370 in healthy fasting subjects. In addition to the effect on pancreatic insulin secretion, the data support an extra-pancreatic (hepatic) component of GKA action.
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Affiliation(s)
- M Sjöstrand
- AstraZeneca R&D, Clinical Early CVGI, MöIndal, Sweden.
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Sievenpiper JL, Chiavaroli L, de Souza RJ, Mirrahimi A, Cozma AI, Ha V, Wang DD, Yu ME, Carleton AJ, Beyene J, Di Buono M, Jenkins AL, Leiter LA, Wolever TMS, Kendall CWC, Jenkins DJA. 'Catalytic' doses of fructose may benefit glycaemic control without harming cardiometabolic risk factors: a small meta-analysis of randomised controlled feeding trials. Br J Nutr 2012; 108:418-23. [PMID: 22354959 PMCID: PMC3411192 DOI: 10.1017/s000711451200013x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 10/24/2011] [Accepted: 01/06/2012] [Indexed: 11/29/2022]
Abstract
Contrary to concerns that fructose may have adverse metabolic effects, there is evidence that small, 'catalytic' doses ( ≤ 10 g/meal) of fructose decrease the glycaemic response to high-glycaemic index meals in human subjects. To assess the longer-term effects of 'catalytic' doses of fructose, we undertook a meta-analysis of controlled feeding trials. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library. Analyses included all controlled feeding trials ≥ 7 d featuring 'catalytic' fructose doses ( ≤ 36 g/d) in isoenergetic exchange for other carbohydrates. Data were pooled by the generic inverse variance method using random-effects models and expressed as mean differences (MD) with 95 % CI. Heterogeneity was assessed by the Q statistic and quantified by I 2. The Heyland Methodological Quality Score assessed study quality. A total of six feeding trials (n 118) met the eligibility criteria. 'Catalytic' doses of fructose significantly reduced HbA1c (MD - 0·40, 95 % CI - 0·72, - 0·08) and fasting glucose (MD - 0·25, 95 % CI - 0·44, - 0·07). This benefit was seen in the absence of adverse effects on fasting insulin, body weight, TAG or uric acid. Subgroup and sensitivity analyses showed evidence of effect modification under certain conditions. The small number of trials and their relatively short duration limit the strength of the conclusions. In conclusion, this small meta-analysis shows that 'catalytic' fructose doses ( ≤ 36 g/d) may improve glycaemic control without adverse effects on body weight, TAG, insulin and uric acid. There is a need for larger, longer ( ≥ 6 months) trials using 'catalytic' fructose to confirm these results.
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Affiliation(s)
- John L Sievenpiper
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
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Abstract
Male Zucker diabetic fatty fa/fa (ZDF) rats develop obesity and insulin resistance at a young age, and then with aging, progressively develop hyperglycemia. This hyperglycemia is associated with impaired pancreatic β-cell function, loss of pancreatic β-cell mass, and decreased responsiveness of liver and extrahepatic tissues to the actions of insulin and glucose. Of particular interest are the insights provided by studies of these animals into the mechanism behind the progressive impairment of carbohydrate metabolism. This feature among others, including the development of obesity- and hyperglycemia-related complications, is common between male ZDF rats and humans with type 2 diabetes associated with obesity. We discuss the diabetic features and complications found in ZDF rats and why these animals are widely used as a genetic model for obese type 2 diabetes.
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Affiliation(s)
- Masakazu Shiota
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Dolan LC, Potter SM, Burdock GA. Evidence-based review on the effect of normal dietary consumption of fructose on blood lipids and body weight of overweight and obese individuals. Crit Rev Food Sci Nutr 2011; 50:889-918. [PMID: 21108071 DOI: 10.1080/10408398.2010.512990] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although some investigators have hypothesized that ingestion of fructose from foods and beverages is responsible for the development of hyperlipidemia or obesity, a recent evidence-based review demonstrated that there was no relationship between the consumption of fructose in a normal dietary manner and the development of hyperlipidemia or increased weight in normal weight individuals. Because overweight and obese individuals may exhibit metabolic abnormalities such as insulin resistance, impaired glucose tolerance, hyperlipedemia, and/or alterations in gut hormones involved in appetite regulation, the findings of fructose studies performed in normal weight subjects may not be particularly relevant for overweight or obese subjects. A systematic assessment of the strength and quality of the studies and their relevance for overweight or obese humans ingesting fructose in a normal dietary manner has not been performed. The purpose of this review was to critically evaluate the existing database for a causal relationship between the ingestion of fructose in a normal, dietary manner and the development of hyperlipidemia or increased body weight in overweight or obese humans, using an evidence-based approach. The results of the analysis indicate that there is no evidence which shows that the consumption of fructose at normal levels of intake causes biologically relevant changes in triglycerides (TG) or body weight in overweight or obese individuals.
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Sievenpiper JL, de Souza RJ, Kendall CWC, Jenkins DJA. Is fructose a story of mice but not men? ACTA ACUST UNITED AC 2011; 111:219-20; author reply 220-2. [PMID: 21272692 DOI: 10.1016/j.jada.2010.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Indexed: 11/30/2022]
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Jenkins DJA, Srichaikul K, Kendall CWC, Sievenpiper JL, Abdulnour S, Mirrahimi A, Meneses C, Nishi S, He X, Lee S, So YT, Esfahani A, Mitchell S, Parker TL, Vidgen E, Josse RG, Leiter LA. The relation of low glycaemic index fruit consumption to glycaemic control and risk factors for coronary heart disease in type 2 diabetes. Diabetologia 2011; 54:271-9. [PMID: 20978741 PMCID: PMC3017317 DOI: 10.1007/s00125-010-1927-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 09/03/2010] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Sugar has been suggested to promote obesity, diabetes and coronary heart disease (CHD), yet fruit, despite containing sugars, may also have a low glycaemic index (GI) and all fruits are generally recommended for good health. We therefore assessed the effect of fruit with special emphasis on low GI fruit intake in type 2 diabetes. METHODS This secondary analysis involved 152 type 2 diabetic participants treated with glucose-lowering agents who completed either 6 months of high fibre or low GI dietary advice, including fruit advice, in a parallel design. RESULTS Change in low GI fruit intake ranged from -3.1 to 2.7 servings/day. The increase in low GI fruit intake significantly predicted reductions in HbA(1c) (r = -0.206, p =0.011), systolic blood pressure (r = -0.183, p = 0.024) and CHD risk (r = -0.213, p = 0.008). Change in total fruit intake ranged from -3.7 to 3.2 servings/day and was not related to study outcomes. In a regression analysis including the eight major carbohydrate foods or classes of foods emphasised in the low GI diet, only low GI fruit and bread contributed independently and significantly to predicting change in HbA(1c). Furthermore, comparing the highest with the lowest quartile of low GI fruit intake, the percentage change in HbA(1c) was reduced by -0.5% HbA(1c) units (95% CI 0.2-0.8 HbA(1c) units, p < 0.001). CONCLUSIONS/INTERPRETATION Low GI fruit consumption as part of a low GI diet was associated with lower HbA(1c), blood pressure and CHD risk and supports a role for low GI fruit consumption in the management of type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT00438698.
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Affiliation(s)
- D J A Jenkins
- Clinical Nutrition & Risk Factor Modification Center, St Michael's Hospital, Toronto, ON, Canada M5C 2T2.
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Winnick JJ, An Z, Ramnanan CJ, Smith M, Irimia JM, Neal DW, Moore MC, Roach PJ, Cherrington AD. Hepatic glycogen supercompensation activates AMP-activated protein kinase, impairs insulin signaling, and reduces glycogen deposition in the liver. Diabetes 2011; 60:398-407. [PMID: 21270252 PMCID: PMC3028338 DOI: 10.2337/db10-0592] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to determine how increasing the hepatic glycogen content would affect the liver's ability to take up and metabolize glucose. RESEARCH DESIGN AND METHODS During the first 4 h of the study, liver glycogen deposition was stimulated by intraportal fructose infusion in the presence of hyperglycemic-normoinsulinemia. This was followed by a 2-h hyperglycemic-normoinsulinemic control period, during which the fructose infusion was stopped, and a 2-h experimental period in which net hepatic glucose uptake (NHGU) and disposition (glycogen, lactate, and CO(2)) were measured in the absence of fructose but in the presence of a hyperglycemic-hyperinsulinemic challenge including portal vein glucose infusion. RESULTS Fructose infusion increased net hepatic glycogen synthesis (0.7 ± 0.5 vs. 6.4 ± 0.4 mg/kg/min; P < 0.001), causing a large difference in hepatic glycogen content (62 ± 9 vs. 100 ± 3 mg/g; P < 0.001). Hepatic glycogen supercompensation (fructose infusion group) did not alter NHGU, but it reduced the percent of NHGU directed to glycogen (79 ± 4 vs. 55 ± 6; P < 0.01) and increased the percent directed to lactate (12 ± 3 vs. 29 ± 5; P = 0.01) and oxidation (9 ± 3 vs. 16 ± 3; P = NS). This change was associated with increased AMP-activated protein kinase phosphorylation, diminished insulin signaling, and a shift in glycogenic enzyme activity toward a state discouraging glycogen accumulation. CONCLUSIONS These data indicate that increases in hepatic glycogen can generate a state of hepatic insulin resistance, which is characterized by impaired glycogen synthesis despite preserved NHGU.
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Affiliation(s)
- Jason J Winnick
- Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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