含果糖糖类与肥胖的重要食物来源：对照喂养试验的系统评价与荟萃分析

Important food sources of fructose-containing sugars and adiposity: A systematic review and meta-analysis of controlled feeding trials.

作者信息

Chiavaroli Laura, Cheung Annette, Ayoub-Charette Sabrina, Ahmed Amna, Lee Danielle, Au-Yeung Fei, Qi XinYe, Back Songhee, McGlynn Néma, Ha Vanessa, Lai Ethan, Khan Tauseef A, Blanco Mejia Sonia, Zurbau Andreea, Choo Vivian L, de Souza Russell J, Wolever Thomas Ms, Leiter Lawrence A, Kendall Cyril Wc, Jenkins David Ja, Sievenpiper John L

机构信息

Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.

出版信息

Am J Clin Nutr. 2023 Apr;117(4):741-765. doi: 10.1016/j.ajcnut.2023.01.023. Epub 2023 Feb 23.

DOI:10.1016/j.ajcnut.2023.01.023

PMID:36842451

Abstract

BACKGROUND

Sugar-sweetened beverages (SSBs) providing excess energy increase adiposity. The effect of other food sources of sugars at different energy control levels is unclear.

OBJECTIVES

To determine the effect of food sources of fructose-containing sugars by energy control on adiposity.

METHODS

In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library were searched through April 2022 for controlled trials ≥2 wk. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars), addition (energy from sugars added), subtraction (energy from sugars subtracted), and ad libitum (energy from sugars freely replaced). Independent authors extracted data. The primary outcome was body weight. Secondary outcomes included other adiposity measures. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence.

RESULTS

We included 169 trials (255 trial comparisons, n = 10,357) assessing 14 food sources at 4 energy control levels over a median 12 wk. Total fructose-containing sugars increased body weight (MD: 0.28 kg; 95% CI: 0.06, 0.50 kg; P = 0.011) in addition trials and decreased body weight (MD: -0.96 kg; 95% CI: -1.78, -0.14 kg; P = 0.022) in subtraction trials with no effect in substitution or ad libitum trials. There was interaction/influence by food sources on body weight: substitution trials [fruits decreased; added nutritive sweeteners and mixed sources (with SSBs) increased]; addition trials [dried fruits, honey, fruits (≤10%E), and 100% fruit juice (≤10%E) decreased; SSBs, fruit drink, and mixed sources (with SSBs) increased]; subtraction trials [removal of mixed sources (with SSBs) decreased]; and ad libitum trials [mixed sources (with/without SSBs) increased]. GRADE scores were generally moderate. Results were similar across secondary outcomes.

CONCLUSIONS

Energy control and food sources mediate the effect of fructose-containing sugars on adiposity. The evidence provides a good indication that excess energy from sugars (particularly SSBs at high doses ≥20%E or 100 g/d) increase adiposity, whereas their removal decrease adiposity. Most other food sources had no effect, with some showing decreases (particularly fruits at lower doses ≤10%E or 50 g/d). This trial was registered at clinicaltrials.gov as NCT02558920 (https://clinicaltrials.gov/ct2/show/NCT02558920).

摘要

背景

提供过多能量的含糖饮料（SSB）会增加肥胖程度。不同能量控制水平下其他糖类食物来源的影响尚不清楚。

目的

确定含果糖糖类的食物来源通过能量控制对肥胖的影响。

方法

在这项系统评价和荟萃分析中，检索了MEDLINE、Embase和Cochrane图书馆截至2022年4月的≥2周的对照试验。我们预先设定了4种能量控制的试验设计：替代（糖类的能量匹配替代）、添加（添加糖类的能量）、减去（减去糖类的能量）和随意摄入（糖类的能量自由替代）。独立作者提取数据。主要结局是体重。次要结局包括其他肥胖指标。使用推荐分级评估、制定和评价（GRADE）来评估证据的确定性。

结果

我们纳入了169项试验（255项试验比较，n = 10357），评估了4种能量控制水平下的14种食物来源，中位时间为12周。在添加试验中，总含果糖糖类增加了体重（MD：0.28 kg；95%CI：0.06，0.50 kg；P = 0.011），在减去试验中降低了体重（MD：-0.96 kg；95%CI：-1.78，-0.14 kg；P = 0.022），而在替代或随意摄入试验中没有影响。食物来源对体重有交互作用/影响：替代试验[水果降低；添加的营养甜味剂和混合来源（与SSB一起）增加]；添加试验[干水果、蜂蜜、水果（≤10%能量）和100%果汁（≤10%能量）降低；SSB、水果饮料和混合来源（与SSB一起）增加]；减去试验[去除混合来源（与SSB一起）降低]；随意摄入试验[混合来源（有/无SSB）增加]。GRADE评分一般为中等。次要结局的结果相似。

结论

能量控制和食物来源介导了含果糖糖类对肥胖的影响。证据充分表明，糖类摄入过多能量（特别是高剂量≥20%能量或100克/天的SSB）会增加肥胖程度，而去除这些糖类则会降低肥胖程度。大多数其他食物来源没有影响，有些显示出降低（特别是较低剂量≤10%能量或50克/天的水果）。该试验在clinicaltrials.gov上注册为NCT02558920（https://clinicaltrials.gov/ct2/show/NCT02558920）。