果糖对餐后甘油三酯的影响：对照喂养试验的系统评价和荟萃分析。

Effect of fructose on postprandial triglycerides: a systematic review and meta-analysis of controlled feeding trials.

机构信息

Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, Toronto, ON, Canada.

Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, Toronto, ON, Canada; Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

出版信息

Atherosclerosis. 2014 Jan;232(1):125-33. doi: 10.1016/j.atherosclerosis.2013.10.019. Epub 2013 Nov 2.

DOI:10.1016/j.atherosclerosis.2013.10.019

PMID:24401226

Abstract

BACKGROUND

In the absence of consistent clinical evidence, concerns have been raised that fructose raises postprandial triglycerides.

PURPOSE

A systematic review and meta-analysis was conducted to assess the effect of fructose on postprandial triglycerides.

DATA SOURCES

Relevant studies were identified from MEDLINE, EMBASE, and Cochrane databases (through September 3, 2013).

DATA SELECTION

Relevant clinical trials of ≥ 7-days were included in the analysis.

DATA EXTRACTION

Two independent reviewers extracted relevant data with disagreements reconciled by consensus. The Heyland Methodological Quality Score (MQS) assessed study quality. Data were pooled by the generic inverse variance method using random effects models and expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed (Cochran Q statistic) and quantified (I(2) statistic).

DATA SYNTHESIS

Eligibility criteria were met by 14 isocaloric trials (n = 290), in which fructose was exchanged isocalorically for other carbohydrate in the diet, and two hypercaloric trials (n = 33), in which fructose supplemented the background diet with excess energy from high-dose fructose compared with the background diet alone (without the excess energy). There was no significant effect in the isocaloric trials (SMD: 0.14 [95% CI: -0.02, 0.30]) with evidence of considerable heterogeneity explained by a single trial. Hypercaloric trials, however, showed a significant postprandial triglyceride raising-effect of fructose (SMD: 0.65 [95% CI: 0.30, 1.01]).

LIMITATIONS

Most of the available trials were small, short, and of poor quality. Interpretation of the isocaloric trials is complicated by the large influence of a single trial.

CONCLUSIONS

Pooled analyses show that fructose in isocaloric exchange for other carbohydrate does not increase postprandial triglycerides, although an effect cannot be excluded under all conditions. Fructose providing excess energy does increase postprandial triglycerides. Larger, longer, and higher-quality trials are needed.

PROTOCOL REGISTRATION

ClinicalTrials.gov identifier, NCT01363791.

摘要

背景

在缺乏一致的临床证据的情况下，人们担心果糖会升高餐后甘油三酯。

目的

进行了系统评价和荟萃分析，以评估果糖对餐后甘油三酯的影响。

数据来源

从 MEDLINE、EMBASE 和 Cochrane 数据库中检索相关研究（截至 2013 年 9 月 3 日）。

数据选择

分析纳入了持续时间至少为 7 天的相关临床试验。

数据提取

两位独立的评审员提取相关数据，如有分歧则通过协商解决。采用 Heyland 方法学质量评分（MQS）评估研究质量。使用随机效应模型，通过通用倒数方差法对数据进行汇总，以标准化均数差值（SMD）和 95%置信区间（CI）表示。评估异质性（Cochran Q 统计量）并进行量化（I² 统计量）。

数据综合

符合纳入标准的 14 项等热量试验（n=290）中，果糖与饮食中的其他碳水化合物等热量交换，2 项高热量试验（n=33）中，果糖与背景饮食相比，额外补充高剂量果糖会增加能量（与背景饮食相比，没有多余的能量）。在等热量试验中，没有发现显著的影响（SMD：0.14[95%CI：-0.02，0.30]），且有一个试验可解释大部分的异质性。然而，高热量试验显示果糖可显著升高餐后甘油三酯（SMD：0.65[95%CI：0.30，1.01]）。