期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 4, 期 9, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.114.001700
关键词
lipids; meta-analysis; nutrition
资金
- Canadian Institutes of Health Research (CIHR) Knowledge Synthesis grant [102078]
- Calorie Control Council
- Province of Ontario Graduate Scholarships
- CIHR Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award
- McMaster University Scholarship
- Province of Ontario Graduate Scholarship
- CIHR Frederick Banting and Charles Best Canada Graduate Scholarships Master's Award
- Banting and Best Diabetes Centre (BBDC)-Novo Nordisk Studentship
- CIHR Postdoctoral Fellowship Award
- Government of Canada through the Canada Research Chair Endowment
- PSI Foundation Graham Farquharson Knowledge Translation Fellowship
- Canadian Diabetes Association Clinician Scientist Award
Background-Debate over the role of fructose in mediating cardiovascular risk remains active. To update the evidence on the effect of fructose on established therapeutic lipid targets for cardiovascular disease (low-density lipoprotein cholesterol [LDL]-C, apolipoprotein B, non-high-density lipoprotein cholesterol [HDL-C]), and metabolic syndrome (triglycerides and HDL-C), we conducted a systematic review and meta-analysis of controlled feeding trials. Methods and Results-MEDLINE, EMBASE, CINHAL, and the Cochrane Library were searched through July 7, 2015 for controlled feeding trials with follow-up >= 7 days, which investigated the effect of oral fructose compared to a control carbohydrate on lipids (LDL-C, apolipoprotein B, non-HDL-C, triglycerides, and HDL-C) in participants of all health backgrounds. Two independent reviewers extracted relevant data. Data were pooled using random effects models and expressed as mean difference with 95% CI. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I-2 statistic). Eligibility criteria were met by 51 isocaloric trials (n=943), in which fructose was provided in isocaloric exchange for other carbohydrates, and 8 hypercaloric trials (n=125), in which fructose supplemented control diets with excess calories compared to the control diets alone without the excess calories. Fructose had no effect on LDL-C, non-HDL-C, apolipoprotein B, triglycerides, or HDL-C in isocaloric trials. However, in hypercaloric trials, fructose increased apolipoprotein B (n=2 trials; mean difference = 0.18 mmol/L; 95% CI: 0.05, 0.30; P=0.005) and triglycerides (n=8 trials; mean difference = 0.26 mmol/L; 95% CI: 0.11, 0.41; P<0.001). The study is limited by small sample sizes, limited follow-up, and low quality scores of the included trials. Conclusions-Pooled analyses showed that fructose only had an adverse effect on established lipid targets when added to existing diets so as to provide excess calories (+21% to 35% energy). When isocalorically exchanged for other carbohydrates, fructose had no adverse effects on blood lipids. More trials that are larger, longer, and higher quality are required.
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