Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milan, Italy, and with 1MED SA, Agno, Switzerland.
Nutr Rev. 2021 Jan 9;79(2):209-226. doi: 10.1093/nutrit/nuaa077.
Free, or added, sugars are considered important determinants in the pandemics of obesity and associated chronic diseases, and fructose has emerged as the sugar of main concern.
The aim of this review was to assess the evidence of the effects of isoenergetic replacement of fructose or high-fructose corn syrup (HFCS) for glucose or sucrose on cardiometabolic markers in controlled dietary intervention trials.
The electronic databases PubMed/MEDLINE, the Cochrane Library, and Embase were searched from 1980 to May 5, 2020.
Studies were eligible if they measured at least one of the following outcomes: total cholesterol, low- and high-density lipoprotein cholesterol, triacylglycerols, apolipoprotein A1, apolipoprotein B, systolic blood pressure, diastolic blood pressure, fasting glucose, and body weight.
For each outcome, the mean values and the corresponding measure of dispersion were extracted after the intervention or control diet.
Fixed-effects and random-effects models were used to pool study-specific estimates. Between-study heterogeneity was assessed by the χ2 test and the I2 statistic and publication bias by the Egger test and funnel plots.
Twenty-five studies involving 1744 volunteers were identified. No significant effects were found when fructose or HFCS was substituted for glucose, except for a slight decrease in diastolic blood pressure when fructose was substituted for glucose. Similarly, no effects were found when fructose or HFCS was substituted for sucrose, except for a small increase, of uncertain clinical significance, of apolipoprotein B when HFCS was substituted for sucrose.
Isoenergetic substitution of fructose or HFCS for glucose or sucrose has no significant effect on most of the cardiometabolic markers investigated; however, some results were affected by residual between-study heterogeneity and studies with high or unclear risk of bias.
PROSPERO registration number CRD42016042930.
游离糖或添加糖被认为是肥胖和相关慢性病流行的重要决定因素，而果糖已成为主要关注的糖。
本综述的目的是评估在对照饮食干预试验中，用等能量的果糖或高果糖玉米糖浆（HFCS）替代葡萄糖或蔗糖对心血管代谢标志物影响的证据。
从 1980 年至 2020 年 5 月 5 日，检索了电子数据库 PubMed/MEDLINE、Cochrane 图书馆和 Embase。
如果研究测量了以下至少一种结果，则符合入选标准：总胆固醇、低密度和高密度脂蛋白胆固醇、三酰甘油、载脂蛋白 A1、载脂蛋白 B、收缩压、舒张压、空腹血糖和体重。
对于每个结果，在干预或对照饮食后提取平均值及其相应的离散度测量值。
采用固定效应和随机效应模型对研究特定估计值进行汇总。通过 χ2 检验和 I2 统计量评估异质性，通过 Egger 检验和漏斗图评估发表偏倚。
共确定了 25 项涉及 1744 名志愿者的研究。当用果糖或 HFCS 替代葡萄糖时，除了用果糖替代葡萄糖时舒张压略有下降外，没有发现显著影响。同样，当用果糖或 HFCS 替代蔗糖时，也没有发现显著影响，除了用 HFCS 替代蔗糖时载脂蛋白 B 略有增加，但增加幅度较小，且具有不确定的临床意义。
用果糖或 HFCS 替代葡萄糖或蔗糖对大多数心血管代谢标志物没有显著影响；然而，一些结果受到残留的异质性和高或不清楚偏倚风险的研究的影响。
PROSPERO 注册号 CRD42016042930。
