Zafar Mohammad Ishraq, Frese Michael, Mills Kerry E
Institute of Reproductive Health/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Faculty of Science and Technology, University of Canberra, Canberra, ACT, Australia.
Front Nutr. 2021 Apr 28;8:647600. doi: 10.3389/fnut.2021.647600. eCollection 2021.
Despite the publication of several of meta-analyses in recent years, the effects of fructose on human health remains a topic of debate. We previously undertook two meta-analyses on post-prandial and chronic responses to isoenergetic replacement of fructose for sucrose or glucose in food or beverages (Evans et al. 2017, AJCN 106:506-518 & 519-529). Here we report on the results of an updated search with a complete re-extraction of previously identified studies and a new and more detailed subgroup-analysis and meta-regression. We identified two studies that were published after our previous analyses, which slightly altered effect sizes and conclusions. Overall, the isoenergetic substitution of fructose for glucose resulted in a statistically significant but clinically irrelevant reduction in fasting blood glucose, insulin, and triglyceride concentrations. A subgroup analysis by diabetes status revealed much larger reductions in fasting blood glucose in people with impaired glucose tolerance and type 2 diabetes. However, each of these subgroups contained only a single study. In people with a healthy body mass index, fructose consumption was associated with statistically significant, but clinically irrelevant reductions in fasting blood glucose and fasting blood insulin. Meta-regression of the outcomes by a number of pre-identified and covariates revealed some sources of heterogeneity, such as year of publication, age of the participants at baseline, and participants' sex. However, the small number of studies and the large number of potential covariates precluded detailed investigations of effect sizes in different subpopulations. For example, well-controlled, high quality studies in people with impaired glucose tolerance and type 2 diabetes are still lacking. Taken together, the available data suggest that chronic consumption of fructose is neither more beneficial, nor more harmful than equivalent doses of sucrose or glucose for glycemic and other metabolic outcomes.
尽管近年来发表了多项荟萃分析，但果糖对人类健康的影响仍是一个有争议的话题。我们之前曾针对食物或饮料中用果糖等量替代蔗糖或葡萄糖后的餐后及慢性反应进行过两项荟萃分析（Evans等人，2017年，《美国临床营养学杂志》106:506 - 518及519 - 529）。在此，我们报告更新检索的结果，对之前纳入的研究进行了完整的重新提取，并进行了新的、更详细的亚组分析和荟萃回归。我们发现两项在我们之前分析之后发表的研究，这两项研究略微改变了效应大小和结论。总体而言，用果糖等量替代葡萄糖会使空腹血糖、胰岛素和甘油三酯浓度出现统计学上显著但临床意义不大的降低。按糖尿病状态进行的亚组分析显示，糖耐量受损者和2型糖尿病患者的空腹血糖降低幅度要大得多。然而，这些亚组中的每一组都仅包含一项研究。在身体质量指数健康的人群中，食用果糖与空腹血糖和空腹血胰岛素出现统计学上显著但临床意义不大的降低有关。对一系列预先确定的协变量进行的结果荟萃回归揭示了一些异质性来源，如发表年份、基线时参与者的年龄以及参与者的性别。然而，研究数量较少且潜在协变量众多，妨碍了对不同亚人群效应大小的详细研究。例如，仍然缺乏针对糖耐量受损者和2型糖尿病患者的严格对照且高质量的研究。综合来看，现有数据表明，就血糖及其他代谢结果而言，长期食用果糖并不比等量的蔗糖或葡萄糖更有益，也不比其更有害。
