Cozma Adrian I, Sievenpiper John L
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada.
Eur Endocrinol. 2014 Feb;10(1):51-60. doi: 10.17925/EE.2014.10.01.51. Epub 2014 Feb 28.
Concerns are growing regarding the role of dietary sugars in the development of obesity and cardiometabolic diseases, including diabetes. High-fructose corn syrup (HFCS) and sucrose are the most important dietary sweeteners. Both HFCS and sucrose have overlapping metabolic actions with adverse effects attributed to their fructose moiety. Ecological studies have linked the rise in fructose availability with the increases in obesity and diabetes worldwide. This link has been largely underpinned by animal models and select human trials of fructose overfeeding at high levels of exposure. Although prospective cohort studies have shown significant associations comparing the highest with the lowest levels of intake sugar-sweetened beverages, these associations are small, do not hold at moderate levels of intake and are subject to collinearity effects from related dietary and lifestyle factors. Most systematic reviews and meta-analyses from controlled feeding trials have shown that fructose-containing sugars in isocaloric exchange for other carbohydrates do not show evidence of harm and, in the case of fructose, may even have advantages for glycaemic control, especially at small doses. Nevertheless, trials in which fructose-containing sugars supplement diets with excess energy have shown adverse effects, effects that appear more attributable to the excess energy than the sugar. There is no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects, although there is potentially cause for concern where fructose is provided at high doses or contributes excess energy to diets. Further investigation is warranted due to the significant knowledge gaps and weaknesses in existing research.
人们越来越关注膳食糖在肥胖症和包括糖尿病在内的心血管代谢疾病发展过程中的作用。高果糖玉米糖浆（HFCS）和蔗糖是最重要的膳食甜味剂。HFCS和蔗糖都有重叠的代谢作用，其不良影响归因于它们的果糖部分。生态学研究将全球范围内果糖可获得性的增加与肥胖症和糖尿病的增加联系起来。这种联系在很大程度上得到了动物模型以及在高暴露水平下对果糖进行过量喂养的部分人体试验的支持。尽管前瞻性队列研究表明，将摄入含糖饮料的最高水平与最低水平进行比较存在显著关联，但这些关联很小，在中等摄入水平时不成立，并且受到相关饮食和生活方式因素的共线性影响。大多数来自对照喂养试验的系统评价和荟萃分析表明，在等热量条件下用含果糖的糖替代其他碳水化合物并未显示出有害证据，就果糖而言，甚至可能对血糖控制有好处，尤其是小剂量时。然而，用含果糖的糖补充能量过剩饮食的试验已显示出不良影响，这些影响似乎更多地归因于能量过剩而非糖本身。没有明确证据表明中等剂量的果糖摄入与不良代谢效应直接相关，尽管在高剂量提供果糖或其为饮食贡献过多能量的情况下可能令人担忧。由于现有研究存在重大知识空白和不足，因此有必要进行进一步调查。
