Special articleAdded Fructose: A Principal Driver of Type 2 Diabetes Mellitus and Its Consequences
Section snippets
Basic Science Data
From an evolutionary standpoint, the body’s response to fructose may have conferred a survival advantage.13 Fructose stimulates epigenetic changes14 and metabolic alterations that shunt calories into storage depots in abdominal fat cells.4 Such effects were desirable for early humans who may have needed to endure long periods of food scarcity. Whereas fructose in Paleolithic times was likely encountered only rarely and seasonally (at least in populations living in nontropical climates) in low
Observational Data
Although fructose is found naturally in some whole foods, such as fruits and vegetables, consumption of these foods poses no problem for human health and indeed may be protective against diabetes and broader cardiometabolic dysfunction.77, 78 Moreover, consumption of whole fruits and vegetables is associated with reduced premature mortality.79 The difference may be a matter of dose and context; fructose in natural foods exists in lower concentrations (eg, the peach example from earlier) and is
Clinical Trials
One human trial investigated the isocaloric exchange of sucrose for starch among individuals with normal glucose tolerance. When sucrose was provided in a “nibbling pattern” (small doses at frequent intervals throughout the day), no statistically significant increase in insulin levels was found,104 suggesting (as with the difference between processed foods and natural fruit) that dose and context are important. However, even lower doses buffered by other dietary constituents resulted in
Discussion
From 1776 to 1994, the estimated consumption of added sugar by Americans increased from 4 lb per person per year to 120 lb per person per year.80 Approximately 75% of all packaged foods and beverages in the United States today have sugars added to them,117 and 13% of the US population consumes at least 25% of their total calories as added sugars.118 Estimated consumption of sugar-sweetened beverages has increased from 10.8 gallons per person per year in 1950 to 49.3 gallons in 2000.80 The
Conclusion
There is no biological need for any added sugars in the diet, particularly those containing fructose (eg, sucrose and HFCS). Although biological response to fructose consumption may have been adaptive for early human ancestors, this response evolved from fructose encountered rarely (at least in populations not living in tropical regions) and in low concentrations in nature. The same biological response is maladaptive when the fructose is encountered frequently and in high concentrations in
References (125)
- et al.
National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants
Lancet
(2011) - et al.
Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985-2011: a modelling study
Lancet Diabetes Endocrinol
(2014) - et al.
Origins and evolution of the Western diet: health implications for the 21st century
Am J Clin Nutr
(2005) - et al.
The composition of a simulated American diet: comparison of chemical analyses and estimates from food composition tables
J Am Diet Assoc
(1978) - et al.
Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity
Am J Clin Nutr
(2004) - et al.
Effect of fructose, dihydroxyacetone, glycerol, and glucose on metabolites and related compounds in liver and kidney
J Biol Chem
(1970) - et al.
Impaired cellular insulin binding and insulin sensitivity induced by high-fructose feeding in normal subjects
Am J Clin Nutr
(1980) - et al.
Cyclic AMP increases the concentration of insulin receptors in cultured fibroblasts and lymphocytes
Biochem Biophys Res Commun
(1977) Fructose: metabolic, hedonic, and societal parallels with ethanol
J Am Diet Assoc
(2010)- et al.
Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study
Am J Clin Nutr
(2012)
Serum insulin and glucose in hyperinsulinemic subjects fed three different levels of sucrose
Am J Clin Nutr
Effect of fructose feeding on insulin secretion and insulin action in the rat
Metabolism
Mechanism of insulin resistance in fructose-fed rats
Metabolism
Fructose-induced in vivo insulin resistance and elevated plasma triglyceride levels in rats
Am J Clin Nutr
Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 wk of supplementation in overweight subjects
Am J Clin Nutr
Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids
Am J Clin Nutr
Fructose-induced hypertension in rats is concentration- and duration-dependent
J Pharmacol Toxicol Methods
Effect of dietary fructose on triglyceride turnover in streptozotocin-diabetic rats
Atherosclerosis
Low dose fructose ingestion during gestation and lactation affects carbohydrate metabolism in rat dams and their offspring
J Nutr
Effects of sucrose vs starch diets on in vivo insulin action, thermogenesis, and obesity in rats
Am J Clin Nutr
Long-term hypertriglyceridemia and glucose intolerance in rats fed chronically an isocaloric sucrose-rich diet
Metabolism
Insulin sensitivity and adipose tissue weight of rats fed starch or sucrose diets ad libitum or in meals
J Nutr
Sucrose-induced insulin resistance in the rat: modulation by exercise and diet
Am J Clin Nutr
Hyperinsulinemia in fructose-induced hypertriglyceridemia in the rat
Metabolism
High-fructose feeding elicits insulin resistance without hypertension in normal mongrel dogs
Am J Hypertens
Isocaloric exchange of dietary starch and sucrose in humans, II: effect on fasting blood insulin, glucose, and glucagon and on insulin and glucose response to a sucrose load
Am J Clin Nutr
Diabetes induced by a high fructose diet
Metabolism
Postprandial plasma fructose level is associated with retinopathy in patients with type 2 diabetes
Metabolism
Identification of fructose as the retinopathic agent associated with the ingestion of sucrose-rich diets in the rat
Metabolism
The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: a randomized controlled trial
Metabolism
Fruit and vegetable consumption and stroke: meta-analysis of cohort studies
Lancet
Fruit and vegetable consumption and all-cause mortality: a dose-response analysis
Am J Clin Nutr
Association of fructose consumption and components of metabolic syndrome in human studies: a systematic review and meta-analysis
Nutrition
Foods contributing to energy intake in the US: data from NHANES III and NHANES 1999–2000
J Food Composit Anal
Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis
Lancet
The effect of fruit in different forms on energy intake and satiety at a meal
Appetite
Relationship of hyperinsulinemia to dietary intake in south Asian and European men
Am J Clin Nutr
CDC News Room Press Release
Good Calories, Bad Calories
Role of insulin resistance in human disease (syndrome X): an expanded definition
Annu Rev Med
New measure of insulin sensitivity predicts cardiovascular disease better than HOMA estimated insulin resistance
PLoS One
Insulin resistance and risk of incident cardiovascular events in adults without diabetes: meta-analysis
PLoS One
Relationship of glucose tolerance and plasma insulin to the incidence of coronary heart disease: results from two population studies in Finland
Diabetes Care
Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations
Diabetes Care
High fructose corn syrup and diabetes prevalence: a global perspective
Glob Public Health
Woodward Award: the evolution of obesity: insights from the mid-Miocene
Trans Am Clin Climatol Assoc
Diet-induced epigenetic regulation in vivo of the intestinal fructose transporter Glut5 during development of rat small intestine
Biochem J
Sugar content of popular sweetened beverages based on objective laboratory analysis: focus on fructose content
Obesity (Silver Spring)
Cited by (129)
Exploring the link between fructose intake and Non-Alcoholic Fatty Liver Disease (NAFLD)
2023, Cahiers de Nutrition et de DietetiqueThe potential therapeutic roles of quercetin and luteolin in hereditary fructose intolerance
2023, Medical HypothesesSugar reduction and sweeteners to improve foods
2023, Strategies to Improve the Quality of FoodsEnzyme-based amperometric biosensors: 60 years later … Quo Vadis?
2022, Analytica Chimica Acta