BACKGROUND AND PURPOSE:

• It is well established that sugary beverages are associated with increased risk of metabolic syndrome (MetS)
  • However, the role of other foods containing fructose sugars in the development of MetS is unclear
• Semnani-Azad et al. (JAMA Network Open, 2020) examined the association of major food sources of fructose-containing sugars with MetS

METHODS:

• Systematic review and meta-analysis
• Data sources
  • MEDLINE | Embase | Cochrane Library (from inception through March 24, 2020)
• Inclusion criteria
  • Prospective cohort studies lasting ≥1 year
  • Studies that investigated the association of important food sources of fructose-containing sugars with incident MetS in participants free of MetS at the start of the study
• Study design and data analysis
  • Risk estimates for each food source with MetS incidence were pooled using a random-effects meta-analysis
  • Certainty of the evidence was assessed using GRADE criteria
  • Most studies included adjustment for confounders
• Primary outcomes
  • Pooled risk ratio of incident MetS

RESULTS:

• 13 studies | 49,591 participants
  • Median (range) age participants: 51 (6 to 90) years
  • Participants with MetS: 14,205
  • Studies assessed 8 fructose-containing foods
• There was an adverse linear dose-response association for sugar-sweetened beverages
  • Risk ratio (RR) for 355 mL/d: 1.14 (95% CI, 1.05 to 1.23)
• There was an L-shaped protective dose-response association for
  • Yogurt
    • RR for 85 g/d: 0.66 (95% CI, 0.58 to 0.76)
  • Fruit
    • RR for 80 g/d: 0.82 (95% CI, 0.78 to 0.86)
• There was a U-shaped dose-response association for fruit juices (100% and mixed) with protection at moderate doses
  • Mixed fruit juice
    • RR for 125 mL/d: 0.58 (95% CI, 0.42 to 0.79)
  • 100% fruit juices
    • RR for 125 mL/d: 0.77 (95% CI, 0.61 to 0.97)
• There was no association with MetS incidence and the following
  • Honey
  • Ice cream
  • Confectionary
• Certainty of evidence
  • Moderate for sugar-sweetened beverages, yogurt, fruit, and fruit juice
  • Very low for all other food sources

CONCLUSION:

• While the consumption of sugar-sweetened beverages is associated with MetS incidence, this association does not seem to extend to other foods containing fructose sugars
  • There was a protective association for fruit flavored yogurt and fruit across the dose range
  • There was a protective association for fruit juices at moderate doses
• The authors suggest that

Generalizing statements on the adverse effects of fructose-containing sugars, however, cannot be extrapolated to other major food sources of fructose-containing sugars

…well-intentioned policies and guidelines to limit sources of free sugars, such as fruit juice or sweetened yogurts, based on evidence from SSBs (sugar-sweetened beverages) may need to be reexamined with a food-based lens

Learn More – Primary Sources:

Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis

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