Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada.
Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Mayo Clin Proc. 2019 Dec;94(12):2399-2414. doi: 10.1016/j.mayocp.2019.05.034.
To determine the association of total and added fructose-containing sugars on cardiovascular (CVD) incidence and mortality.
MEDLINE, EMBASE and Cochrane Library were searched from January 1, 1980, to July 31, 2018. Prospective cohort studies assessing the association of reported intakes of total, sucrose, fructose and added sugars with CVD incidence and mortality in individuals free from disease at baseline were included. Risk estimates were pooled using the inverse variance method, and dose-response analysis was modeled.
Eligibility criteria were met by 24 prospective cohort comparisons (624,128 unique individuals; 11,856 CVD incidence cases and 12,224 CVD mortality cases). Total sugars, sucrose, and fructose were not associated with CVD incidence. Total sugars (risk ratio, 1.09 [95% confidence interval, 1.02 to 1.17]) and fructose (1.08 [1.01 to 1.15]) showed a harmful association for CVD mortality, there was no association for added sugars and a beneficial association for sucrose (0.94 [0.89 to 0.99]). Dose-response analyses showed a beneficial linear dose-response gradient for sucrose and nonlinear dose-response thresholds for harm for total sugars (133 grams, 26% energy), fructose (58 grams, 11% energy) and added sugars (65 grams, 13% energy) in relation to CVD mortality (P<.05). The certainty of the evidence using GRADE was very low for CVD incidence and low for CVD mortality for all sugar types.
Current evidence supports a threshold of harm for intakes of total sugars, added sugars, and fructose at higher exposures and lack of harm for sucrose independent of food form for CVD mortality. Further research of different food sources of sugars is needed to define better the relationship between sugars and CVD. REGISTRATION: clinicaltrials.gov, NCT01608620.
确定总糖和添加糖与心血管疾病（CVD）发病率和死亡率的关系。
从 1980 年 1 月 1 日到 2018 年 7 月 31 日，检索 MEDLINE、EMBASE 和 Cochrane 图书馆。纳入了基线时无疾病的个体报告的总摄入量、蔗糖、果糖和添加糖与 CVD 发病率和死亡率之间的相关性的前瞻性队列研究。使用逆方差法汇总风险估计值，并进行剂量-反应分析。
24 项前瞻性队列比较符合入选标准（624128 个独特个体；11856 例 CVD 发病病例和 12224 例 CVD 死亡病例）。总糖、蔗糖和果糖与 CVD 发病率无关。总糖（风险比，1.09[95%置信区间，1.02 至 1.17]）和果糖（1.08[1.01 至 1.15]）与 CVD 死亡率呈有害关联，添加糖无关联，蔗糖呈有益关联（0.94[0.89 至 0.99]）。剂量-反应分析显示，蔗糖呈有益的线性剂量-反应梯度，而总糖（133 克，占 26%的能量）、果糖（58 克，占 11%的能量）和添加糖（65 克，占 13%的能量）与 CVD 死亡率的非线性剂量-反应阈值呈有害关联（P<.05）。使用 GRADE 评估，所有糖类型的 CVD 发病率的证据确定性为极低，而 CVD 死亡率的证据确定性为低。
目前的证据支持总糖、添加糖和果糖摄入量存在危害阈值，而蔗糖无论食物形式如何，摄入量增加都不会对 CVD 死亡率造成危害。需要进一步研究不同糖源食物，以更好地定义糖与 CVD 之间的关系。
clinicaltrials.gov，NCT01608620。
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