Toronto 3D (Diet, Digestive Tract, and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, 61 Queen Street East, Toronto, ON, M5C 2T2, Canada.
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
BMJ. 2018 Nov 21;363:k4644. doi: 10.1136/bmj.k4644.
To assess the effect of different food sources of fructose-containing sugars on glycaemic control at different levels of energy control.
Systematic review and meta-analysis of controlled intervention studies.
Medine, Embase, and the Cochrane Library up to 25 April 2018.
Controlled intervention studies of at least seven days' duration and assessing the effect of different food sources of fructose-containing sugars on glycaemic control in people with and without diabetes were included. Four study designs were prespecified on the basis of energy control: substitution studies (sugars in energy matched comparisons with other macronutrients), addition studies (excess energy from sugars added to diets), subtraction studies (energy from sugars subtracted from diets), and ad libitum studies (sugars freely replaced by other macronutrients without control for energy). Outcomes were glycated haemoglobin (HbA1c), fasting blood glucose, and fasting blood glucose insulin.
Four independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by random effects models and overall certainty of the evidence assessed by the GRADE approach (grading of recommendations assessment, development, and evaluation).
155 study comparisons (n=5086) were included. Total fructose-containing sugars had no harmful effect on any outcome in substitution or subtraction studies, with a decrease seen in HbA1c in substitution studies (mean difference -0.22% (95% confidence interval to -0.35% to -0.08%), -25.9 mmol/mol (-27.3 to -24.4)), but a harmful effect was seen on fasting insulin in addition studies (4.68 pmol/L (1.40 to 7.96)) and ad libitum studies (7.24 pmol/L (0.47 to 14.00)). There was interaction by food source, with specific food sources showing beneficial effects (fruit and fruit juice) or harmful effects (sweetened milk and mixed sources) in substitution studies and harmful effects (sugars-sweetened beverages and fruit juice) in addition studies on at least one outcome. Most of the evidence was low quality.
Energy control and food source appear to mediate the effect of fructose-containing sugars on glycaemic control. Although most food sources of these sugars (especially fruit) do not have a harmful effect in energy matched substitutions with other macronutrients, several food sources of fructose-containing sugars (especially sugars-sweetened beverages) adding excess energy to diets have harmful effects. However, certainty in these estimates is low, and more high quality randomised controlled trials are needed.
Clinicaltrials.gov (NCT02716870).
评估不同果糖来源的含糖食物对不同能量控制水平下血糖控制的影响。
对对照干预研究进行系统评价和荟萃分析。
截至 2018 年 4 月 25 日，在 Medline、Embase 和 Cochrane 图书馆进行检索。
至少持续 7 天的对照干预研究，并评估糖尿病患者和非糖尿病患者中不同果糖来源的含糖食物对血糖控制的影响。基于能量控制，预先指定了四种研究设计：替代研究（与其他宏量营养素进行能量匹配比较的糖）、添加研究（在饮食中添加多余的糖能量）、减法研究（从饮食中减去糖的能量）和随意研究（糖自由替换为其他宏量营养素而不控制能量）。结局指标为糖化血红蛋白（HbA1c）、空腹血糖和空腹血糖胰岛素。
四名独立的审稿人提取了相关数据并评估了偏倚风险。采用随机效应模型对数据进行汇总，并采用 GRADE 方法（推荐评估、制定和评价分级）评估证据的总体确定性。
纳入了 155 项研究比较（n=5086）。总果糖来源的含糖食物对替代或减法研究中的任何结局均无不良影响，替代研究中 HbA1c 下降（平均差值-0.22%（95%置信区间-0.35%至-0.08%），-25.9mmol/mol（-27.3 至-24.4）），但添加研究中空腹胰岛素升高（4.68pmol/L（1.40 至 7.96））和随意研究中升高（7.24pmol/L（0.47 至 14.00））。食物来源存在交互作用，特定食物来源（水果和果汁）在替代研究中有有益作用，而在添加研究中（加糖牛奶和混合来源）有不良作用，在添加研究中（含糖饮料和果汁）有不良作用。大多数证据质量较低。
能量控制和食物来源似乎调节了果糖来源的含糖食物对血糖控制的影响。尽管这些糖的大多数食物来源（尤其是水果）与其他宏量营养素进行能量匹配替代时没有不良影响，但饮食中添加多余能量的几种果糖来源的含糖食物（尤其是含糖饮料）有不良影响。然而，这些估计的确定性较低，需要更多高质量的随机对照试验。
Clinicaltrials.gov（NCT02716870）。
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