Summary of “Fructose replacement of glucose or sucrose in food or beverages lowers postprandial glucose and insulin without raising triglycerides: a systematic review and meta-analysis”

For your information, an article entitled “Fructose replacement of glucose or sucrose in food or beverages lowers postprandial glucose and insulin without raising triglycerides: a systematic review and meta-analysis” by Evans et al. was recently published in the American Journal of Clinical Nutrition. In the present study, Evans et al. conducted a systematic review and meta-analysis to explore the impact of replacing glucose or sucrose with fructose in diabetics and non-diabetics as well as in lean, overweight, and obese populations.

The authors collected data from 47 trials including 81 comparison arms which met the following criteria: 1) the intervention was fructose; 2) the control was either glucose or sucrose; 3) the replacement was isoenergetic (equal number of grams of sugar in each arm); 4) the study was a randomized controlled trial; 5) the study period was ≥45 min postprandial; and 6) the study presented data on peak postprandial blood glucose.

Evans et al. found that 62 study arms substituted fructose for glucose and 19 substituted fructose for sucrose. Results of the subgroup analyses are provided below.

  • A subgroup analysis by diabetes status (normoglycemic, impaired glucose tolerance, type 1 diabetes, type 2 diabetes) was conducted to determine the effects on postprandial blood glucose.
    • Overall, the replacement of fructose for glucose resulted in a reduction in peak postprandial glycemia (-2.34mmol/L).
    • Those with type 2 diabetes showed the greatest reduction in glycemia (-4.66 mmol/L).
    • When replacing sucrose with fructose, the results were similar but of smaller magnitude.
    • Researchers conducted an additional analysis in normoglyemic individuals and found that an increased body weight was correlated with a greater reduction in peak blood glucose.
  • A subgroup analysis by diabetes status (normoglycemic, impaired glucose tolerance, type 1 diabetes, type 2 diabetes) was conducted to determine the effects on postprandial insulin.
    • Replacing fructose for glucose in normoglycemic populations resulted in a reduction in peak postprandial insulin (-45.15 IU/mL).
    • The impaired glucose tolerance population demonstrated an even greater reduction in postprandial insulin (-60.12 IU/mL).
    • Similar results were observed in the sucrose replacement studies.
    • Researchers conducted an additional analysis in normoglyemic individuals and found that healthy and overweight populations had a similar insulin response but that obese populations demonstrated a greater reduction in postprandial insulin.
  • Evans et al. conducted a meta-regression of postprandial glucose concentrations considering treatment dose, diabetes status, and body weight. There were highly significant correlations for treatment dose, diabetes, and overweight status.
  • A subgroup analysis in healthy weight, normoglycemic populations to determine if the presentation of the test sugar (food vs beverage) impacted outcomes. There were no difference between these subgroups.
  • Evans et al. also conducted a meta-analysis of 14 studies to determine effects of blood triglycerides following glucose or sucrose replacement with fructose and found no significant changes.

Evans et al. conclude “The finding that postprandial peak blood glucose concentrations were lowered in those consuming fructose was not unexpected…We found that peak blood glucose reductions are more pronounced in individuals with impaired glucose tolerance or type 1 or type 2 diabetes. This reinforces the potential benefits for glycemic control from the isoenergetic exchange of glucose or sucrose in food or beverages with fructose.” The authors also assert that “The results of our systematic review and meta-analysis on isoenergetic exchange of glucose or sucrose by fructose suggest that there are benefits to fructose consumption without concomitant adverse effects on blood lipids.”

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