Effect of Fructose on Glycemic Control in Diabetes

A systematic review and meta-analysis of controlled feeding trials

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Foods are ranked 0 to 3 stars, with three stars awarded to most nutritious foods. Diabetes Care ; 9: The following year Kraft launches a similar initiative, called Sensible Solutions. PLoS Med ; 6: There are currently no meta-analyses investigating the effect of fructose on LDL. Oleomargarine Act requires prominent labeling of colored oleomargarine, to distinguish it from butter. Clin Nutr ;

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One possibility is that the addition of fructose to the diet may help control postprandial glycemic excursions. The resulting fructoseP is able to displace fructoseP from its binding site on the glucokinase regulatory protein, allowing increased translocation of glucokinase from the nucleus to the cytosol, where it is active. Both these mechanisms may be operating. Although it appears that isocaloric fructose feeding benefits glycemia, a dose threshold for harm must also be considered because fructose, more than other sources of carbohydrate, may increase serum triglycerides.

We therefore must consider the possible adverse effects of substituting fructose for other carbohydrates at high doses. There are currently no meta-analyses investigating the effect of fructose on LDL. A number of limitations complicate the interpretation of these aggregate analyses. Second, several studies included participants who were receiving insulin or oral hypoglycemic agents, treatments that in themselves would be expected to influence glycemia.

Third, given the small number of trials included in each stratum, meta-regression may have been underpowered to detect true differences. Fourth, a significant amount of unexplainable heterogeneity was detected in both primary and subgroup analyses, although our random-effects model did account for this heterogeneity. These deficiencies were especially of concern in the context of the small sample sizes, with most of the trials having 15 or fewer participants.

Finally, because only published trials were included, publication bias remains a possibility for all outcomes, although we noted statistical evidence of publication bias only for fasting glucose. The harm-reduction approach to fructose taken by diabetes associations 2 , 7 , 8 , which is based on possible adverse serum lipid effects, may need to be reconciled with a possible glycemic benefit.

These conclusions, however, are limited by the short follow-up, small sample size, and poor quality of most trials included in our meta-analysis, as well as the large degree of unexplained significant heterogeneity. Larger, longer, and higher-quality trials of controlled fructose feeding that also weigh any possible glycemic benefit against adverse metabolic effects are required for definitive confirmation of these findings.

None of the sponsors had a role in any aspect of the current study, including design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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Skip to main content. Diabetes Care Jul; 35 7: Data extraction Reports that met the inclusion criteria were each independently reviewed and extracted by at least two investigators with a standardized form. RESULTS Search results A total of 4, eligible reports were identified with the search; of these, 4, were determined to be irrelevant on review of the titles and abstracts. Figure 1 Flowchart of literature search for the effect of fructose on glycemic end points fasting glucose, fasting insulin, and glycated blood proteins [HbA 1c and glycated albumin].

View inline View popup Download powerpoint. Table 1 Characteristics of experimental trials included in the meta-analysis. Download figure Open in new tab Download powerpoint. Figure 2 Forest plot of controlled feeding trials investigating the effect of isocaloric exchange of fructose for other carbohydrate on A glycated blood proteins HbA 1c and glycated albumin , B fasting glucose, and C fasting insulin. Publication bias Supplementary Figs.

Footnotes Clinical trial reg. The World Health Report Life in the 21st Century: A Vision for All. Geneva, World Health Organization, Canadian Diabetes Association clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes ; Height, predictors of C-peptide and cancer risk in men.

Int J Epidemiol ; National estimates of dietary fructose intake increased from to in the United States. J Nutr ; Intakes and food sources of fructose in the United States.

Am J Clin Nutr ; 58 Suppl: Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr ; Nutrition recommendations and interventions for diabetes: Diabetes Care ; 31 Suppl.

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Médecine et Nutrition ; Metabolic effects of dietary fructose and sucrose in types I and II diabetic subjects. JAMA ; Cochrane Handbook for Systematic Reviews of Interventions. Oxford, UK , Cochrane Collaboration , Accessed on 15 May Preferred reporting items for systematic reviews and meta-analyses: PLoS Med ; 6: Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. Meta-analyses involving cross-over trials: Metabolic effects of dietary fructose in diabetic subjects.

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Diabetes Care ; 9: The effects of one month high fructose intake on plasma glucose and lipid levels in non-insulin-dependent diabetes. Diabet Med ; 4: Lipid metabolism in non-insulin-dependent diabetes: Center for Drug Evaluation and Research. Rockville, Md , U. Oral antihyperglycemic therapy for type 2 diabetes: Livesey G , Taylor R.

Fructose consumption and consequences for glycation, plasma triacylglycerol, and body weight: Diabetes Care ; 6: Heterogeneous effects of fructose on blood lipids in individuals with type 2 diabetes: International tables of glycemic index and glycemic load values: The use of low-glycaemic index diets in diabetes control.

Br J Nutr ; Fructose improves the ability of hyperglycemia per se to regulate glucose production in type 2 diabetes. This is pretty much the nutrition label as we know it today. Food labels are to list the most important nutrients in an easy-to-follow format. Criteria are simple—low in saturated fat and cholesterol, for healthy people over age 2.

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Advocates believe it will make more information available to the public. The following year Kraft launches a similar initiative, called Sensible Solutions.

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